NEET-PG 2015 Practice Questions

Q: Reduced osmolarity ORS does not contain which of the following ions?

Lactate. ***Lactate*** - The **reduced osmolarity ORS** formulation replaced **bicarbonate** with **citrate** and does not contain lactate. - **Citrate** is preferred over lactate / bicarbonate due to its stability, longer shelf life, and ease of dissolution. *Sodium* - **Sodium** is a crucial component of ORS, as it is co-transported with glucose into enterocytes, facilitating water absorption through **solvent drag**. - Reduced osmolarity ORS has a **lower sodium concentration** (75 mEq/L) compared to standard ORS (90 mEq/L) to minimize hypernatremia risk and enhance water absorption. *Potassium* - **Potassium** is included in ORS to replace intestinal losses, as **diarrhea** leads to significant potassium depletion. - Maintaining adequate **potassium levels** is essential for normal cellular function and preventing hypokalemia-related complications. *Citrate* - **Citrate** is a component of ORS that serves as an **alkalinizing agent** to correct metabolic acidosis often associated with dehydration in diarrheal diseases. - It also enhances the absorption of sodium and water in the intestine.

Q: In which part of the body are lesions of Kaposi sarcoma most commonly seen?

Lower extremities. ***Lower extremities*** - Kaposi sarcoma lesions most frequently appear on the **skin of the lower extremities**, especially the feet and ankles. - This predilection is thought to be due to increased **venous stasis** or other local factors. *Upper extremities* - While Kaposi sarcoma can affect the upper extremities, it is a **less common primary site** compared to the lower limbs. - Lesions here are more likely to appear as the disease **progresses or disseminates**. *Torso* - Kaposi sarcoma lesions can occur on the torso, particularly on the **trunk**, but it is not the most common initial presentation. - Visceral involvement of the **gastrointestinal tract** and lungs can often present without skin lesions on the torso. *Head and neck* - Lesions of Kaposi sarcoma can appear on the head and neck, especially on the **face and oral cavity**, particularly in classic Kaposi sarcoma or in individuals with advanced immunosuppression. - However, this is still **less frequent** than involvement of the lower extremities.

Q: Crush Syndrome is associated with all of the following features except -

Hypercalcemia. ***Hypercalcemia*** - Crush syndrome involves massive **muscle damage** leading to the release of intracellular contents, but hypercalcemia is not typically seen acutely. - While skeletal muscle contains calcium, its release, if any, is usually outweighed by other electrolyte shifts and renal dysfunction, often leading to **hypocalcemia** due to calcium binding to damaged tissues and phosphate. *Hypocalcemia* - This is a common feature of **crush syndrome** because calcium ions move into damaged cells and bind to free fatty acids and damaged tissue. - The elevated **phosphate levels** released from damaged cells can also bind to circulating calcium, further reducing serum calcium. *Hyperkalemia* - One of the most dangerous complications of **crush syndrome**, resulting from the massive release of **intracellular potassium** from damaged muscle cells. - Can lead to **life-threatening arrhythmias** if not promptly managed. *Increased serum creatinine* - Damaged muscle releases large amounts of **creatinine**, which is a byproduct of muscle metabolism; this, along with **myoglobin** (leading to acute kidney injury), causes a significant increase in serum creatinine levels. - **Acute kidney injury** due to rhabdomyolysis is a hallmark of crush syndrome, leading to impaired clearance of waste products.

Q: Which of the following is the most common initial presenting feature of multiple sclerosis:

Optic Neuritis. ***Optic Neuritis*** - **Optic neuritis** is a very common initial symptom of multiple sclerosis, occurring in 20-25% of patients. - It presents with **unilateral vision loss** (often painful), blurred vision, and a central scotoma, reflecting inflammation and demyelination of the optic nerve [1]. *Cerebellar Ataxia* - While **cerebellar ataxia** (impaired coordination, balance, speech) can occur in MS, it is less common as an initial presenting symptom. - It often develops later in the disease course due to demyelination in the **cerebellum** or its connections [1]. *Internuclear ophthalmoplegia* - **Internuclear ophthalmoplegia (INO)** is a specific eye movement disorder common in MS but rarely the very first symptom [1]. - It results from a lesion in the **medial longitudinal fasciculus (MLF)**, causing impaired adduction of one eye during conjugate gaze with nystagmus in the abducting eye. *Diplopia* - **Diplopia** (double vision) can be an early symptom of MS, but it is less frequent as the very first presentation compared to optic neuritis [1]. - It typically arises from lesions affecting the **cranial nerves** controlling eye movements (III, IV, VI) or their brainstem nuclei.

Q: What does the term 'crowning' refer to in the context of childbirth?

Biparietal diameter at the vulval outlet. ***Biparietal diameter at the vulval outlet*** - **Crowning** specifically refers to the moment when the largest diameter of the baby's head (the **biparietal diameter**) has passed through the pelvic outlet and becomes visible at the vaginal opening without receding between contractions. - This signifies that the head is fully engaged and will no longer slip back, making birth imminent. *Biparietal diameter at the inlet of pelvis* - The **biparietal diameter** at the inlet of the pelvis describes the initial engagement of the fetal head into the pelvis, which is a much earlier stage than crowning. - This stage is referred to as **engagement**, not crowning, and there is no visible head at this point. *Biparietal diameter at the ischial spine* - The **ischial spines** are a landmark often used to assess the fetal head's station in the pelvis (how far down it has descended). - While important for assessing progress, the biparietal diameter reaching the ischial spines indicates a **station 0**, which is still internal and not visible at the vulva, thus not crowning. *Biparietal diameter just outside the vulval outlet* - If the **biparietal diameter** is **just outside** the vulval outlet, it implies the head has already been born or is so far progressed that crowning has already occurred or the head is delivering. - Crowning specifically describes the moment it becomes visible and sustained at the outlet, not outside it.

Q: Poor prognostic factor for hydatidiform mole is -

WHO score > 8. ***WHO score > 8*** - A **WHO score > 8** (more specifically, WHO/FIGO score ≥7) indicates **high-risk gestational trophoblastic neoplasia (GTN)**, which is associated with a poor prognosis and requires multi-agent chemotherapy. - The WHO prognostic scoring system incorporates various factors: age, prior pregnancy outcome, antecedent pregnancy type, interval from index pregnancy, pre-treatment hCG level, largest tumor size, site of metastases, and number of metastases. - This is the **strongest poor prognostic indicator** among the options listed. *Prior molar pregnancy* - A **prior molar pregnancy** increases the *risk* of developing another molar pregnancy (recurrence risk ~1-2%), but it is **not a component of the WHO prognostic scoring system** and is not a poor prognostic factor for the outcome of current GTN. - The history affects surveillance requirements but doesn't dictate the difficulty of treating the current episode. *Metastasis to lung* - **Lung metastases** are actually among the **better prognostic sites** for metastatic GTN in the WHO scoring system. - Lung and vaginal metastases score only 1 point, whereas liver and brain metastases (true poor prognostic sites) score 4 points each. - While any metastasis indicates more advanced disease, isolated lung metastases generally have a *good prognosis* with appropriate chemotherapy, with cure rates >90%. *No prior chemotherapy* - The *absence* of **prior chemotherapy** is a **favorable prognostic factor**, not a poor one. - Patients who have *failed* prior chemotherapy or have received ≥2 drugs previously score 2-4 points in the WHO system, indicating worse prognosis. - No prior chemotherapy (scores 0 points) means better treatment response and outcomes.

Q: Which is the most common type of male breast cancer?

Invasive Ductal Carcinoma. ***Invasive Ductal Carcinoma*** - This is by far the most common type of breast cancer in men, accounting for approximately **80-90%** of all male breast cancer cases. - It originates in the **milk ducts** and then invades the surrounding breast tissue. *Invasive Lobular Carcinoma* - This type of cancer originates in the **milk-producing glands (lobules)**. - It is **extremely rare** in men due to the underdeveloped and non-functional lobules in the male breast. *Mucinous Carcinoma* - This is a **rare subtype** of invasive ductal carcinoma characterized by cancer cells that produce **mucin**. - It accounts for only a small percentage of male breast cancers, typically **2-3%** of cases. *Inflammatory Breast Cancer* - This is a **rare and aggressive** form of breast cancer characterized by rapid onset of redness, swelling, and warmth in the breast, often mistaken for an infection. - Although it can occur in men, it is not the most common type and represents a very small fraction of male breast cancer diagnoses.

Q: What is the primary treatment for early-stage non-small cell lung cancer?

Surgical resection. ***Surgical resection*** - **Surgical resection** (lobectomy or segmentectomy with lymph node dissection) is the **primary and definitive treatment** for early-stage non-small cell lung cancer (Stage I-II). - For **Stage IA disease**, surgery alone provides excellent outcomes with 5-year survival rates of 70-90%, and adjuvant chemotherapy is generally **not indicated**. - For **Stage IB-II**, surgery remains primary, with adjuvant chemotherapy considered selectively based on tumor size (>4 cm), poor differentiation, vascular invasion, or other high-risk features. - Complete surgical resection offers the **best chance of cure** for resectable early-stage NSCLC. *Surgical resection with adjuvant chemotherapy* - While this combination is important for **select early-stage cases** (high-risk Stage IB, Stage II-IIIA), it is **not the universal primary treatment** for all early-stage disease. - Adjuvant chemotherapy is an **addition** to surgery in specific scenarios, not part of the primary treatment for the majority of early-stage (especially Stage IA) patients. - Current guidelines recommend risk stratification before adding adjuvant therapy. *Radiotherapy* - **Radiotherapy** (stereotactic body radiotherapy/SBRT) is reserved for **medically inoperable** patients or those who refuse surgery. - It is not the primary treatment when the patient is a **surgical candidate**. - May be used as adjuvant therapy in patients with positive margins or N2 disease. *Immunotherapy* - **Immunotherapy** has emerging roles in neoadjuvant/adjuvant settings for resectable NSCLC (recent trials showing benefit). - However, it is **not established as primary monotherapy** for early resectable disease. - More commonly used in advanced/metastatic NSCLC or as part of combination regimens in clinical trial settings for early disease.

Q: What is the most common cause of lateral aberrant thyroid tissue?

Metastatic thyroid carcinoma. ***Metastatic thyroid carcinoma*** - **Metastatic papillary thyroid carcinoma** to cervical lymph nodes is the most common cause of lateral aberrant thyroid tissue - The term "lateral aberrant thyroid" is a **historical misnomer** that has been abandoned in modern thyroid surgery - What was previously thought to be ectopic thyroid tissue in lateral neck nodes is virtually always **metastatic disease** - Papillary thyroid carcinoma commonly metastasizes to **regional lymph nodes**, which then contain thyroid follicular cells - This represents **lymph node metastases**, not developmental ectopia *Ectopic thyroid tissue due to developmental anomalies* - True developmental ectopia of thyroid tissue in the **lateral neck is extremely rare to nonexistent** - The thyroid gland originates from the **foramen cecum in the midline** and descends along the thyroglossal duct - Developmental ectopic thyroid occurs in **midline structures** (lingual thyroid, thyroglossal duct remnants), not laterally - The concept of "lateral aberrant thyroid" as a developmental anomaly has been **disproven** *Thyroid tissue in the mediastinum* - Mediastinal thyroid tissue represents **substernal or retrosternal goiter** that has descended into the chest - This describes a different anatomical location (mediastinum vs. lateral neck) - Not related to lateral cervical masses *Lingual thyroid* - Lingual thyroid is ectopic thyroid tissue located at the **base of the tongue** - This is a **midline structure**, not a lateral neck finding - Represents failure of thyroid descent during embryological development

Q: A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Surgical removal of the prostate (Radical prostatectomy). ***Surgical removal of the prostate (Radical prostatectomy)*** - **Radical prostatectomy** is the **definitive treatment of choice** for **localized prostate cancer (T2a)** in patients with **good life expectancy (>10 years)**. - For a **65-year-old patient** with tumor confined to the prostate, **surgical removal offers excellent disease control** and potential cure. - This is the **preferred option** when the patient is **medically fit for surgery** and has adequate life expectancy. *External beam radiation therapy* - **External beam radiation therapy (EBRT)** is also an effective treatment for **localized T2a prostate cancer** with comparable long-term survival outcomes. - However, **radical prostatectomy is generally preferred** in younger, healthier patients as it: - Provides definitive pathological staging - Allows for immediate assessment of surgical margins - Preserves radiation as a salvage option if needed - EBRT is better suited for patients who are **not surgical candidates** due to comorbidities or patient preference. *Active surveillance* - **Active surveillance** is appropriate for **very low-risk prostate cancer** (T1c, PSA <10, Gleason ≤6). - For **T2a disease** (palpable tumor), the risk of progression is significant, making active surveillance **not the most appropriate first-line option**. - Would be considered only in patients with limited life expectancy or significant comorbidities. *Androgen deprivation therapy (ADT)* - **ADT** is used for **advanced, locally advanced, or metastatic prostate cancer** to reduce testosterone and slow tumor growth. - It is **not curative** and not appropriate as **monotherapy for localized T2a disease**. - May be used as adjuvant therapy with radiation in higher-risk cases, but not as primary treatment alone.

Question 1

Reduced osmolarity ORS does not contain which of the following ions?

Accepted Answer

Lactate

Answer

Sodium

Answer

Potassium

Answer

Citrate

Question 2

In which part of the body are lesions of Kaposi sarcoma most commonly seen?

Accepted Answer

Lower extremities

Answer

Upper extremities

Answer

Torso

Answer

Head and neck

Question 3

Crush Syndrome is associated with all of the following features except -

Accepted Answer

Hypercalcemia

Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Increased serum creatinine

Question 4

Which of the following is the most common initial presenting feature of multiple sclerosis:

Accepted Answer

Optic Neuritis

Answer

Cerebellar Ataxia

Answer

Internuclear ophthalmoplegia

Answer

Diplopia

Question 5

What does the term 'crowning' refer to in the context of childbirth?

Accepted Answer

Biparietal diameter at the vulval outlet

Answer

Biparietal diameter at the inlet of pelvis

Answer

Biparietal diameter at the ischial spine

Answer

Biparietal diameter just outside the vulval outlet

Question 6

Poor prognostic factor for hydatidiform mole is -

Accepted Answer

WHO score > 8

Answer

Prior molar pregnancy

Answer

Metastasis to lung

Answer

No prior chemotherapy

Question 7

Which is the most common type of male breast cancer?

Accepted Answer

Invasive Ductal Carcinoma

Answer

Inflammatory Breast Cancer

Answer

Invasive Lobular Carcinoma

Answer

Mucinous Carcinoma

Question 8

What is the primary treatment for early-stage non-small cell lung cancer?

Accepted Answer

Surgical resection

Answer

Radiotherapy

Answer

Surgical resection with adjuvant chemotherapy

Answer

Immunotherapy

Question 9

What is the most common cause of lateral aberrant thyroid tissue?

Accepted Answer

Metastatic thyroid carcinoma

Answer

Ectopic thyroid tissue due to developmental anomalies

Answer

Thyroid tissue in the mediastinum

Answer

Lingual thyroid

Question 10

A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Accepted Answer

Surgical removal of the prostate (Radical prostatectomy)

Answer

External beam radiation therapy

Answer

Androgen deprivation therapy (ADT)

Answer

Active surveillance

NEET-PG 2015

Community Medicine

Dermatology

Internal Medicine

Obstetrics and Gynecology

Pathology

Surgery