Internal Medicine
1 questionsWhich zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1151: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
- A. Central zone
- B. Peripheral zone
- C. Transitional zone (Correct Answer)
- D. Prostate capsule
Explanation: ***Transitional zone*** - The **transitional zone** surrounds the urethra and is the primary site of origin and enlargement in **Benign Prostatic Hyperplasia (BPH)**. - Its hypertrophy leads to compression of the urethra, causing **lower urinary tract symptoms (LUTS)**. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is less commonly involved in BPH. - It is more frequently associated with the development of **prostate carcinoma**. *Peripheral zone* - The **peripheral zone** is the largest zone of the prostate and is where the majority of prostate cancers originate. - While it can be affected by BPH, it is not the primary zone for hypertrophy. *Prostate capsule* - The **prostate capsule** is the outer fibrous layer that encloses the prostate gland. - It does not undergo hyperplasia in BPH; rather, it encases the enlarging gland.
Surgery
9 questionsWhich of the following is NOT a feature of membranous urethral injury?
A high-riding prostate is indicative of which injury?
Prostate cancer that is limited to the capsule and not the urethra would be staged as -
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?
What is the appropriate management for a patient with a carcinoid tumor of the appendix larger than 2 cm?
A 25 year old male is receiving conservative management for an appendicular mass since 3 days now presents with a rising pulse rate, tachycardia and fever. The mode of management must be -
Under what guidelines is treatment started for a patient presenting with appendicular mass on a CT scan?
Treatment of choice for mucinous carcinoma of the gall bladder in the early stage is -
What is the primary indication for the Nigro Regimen?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1151: Which of the following is NOT a feature of membranous urethral injury?
- A. blood at the meatus
- B. Retention of urine
- C. Pelvic fracture
- D. Perineal butterfly hematoma (Correct Answer)
Explanation: ***Perineal butterfly hematoma*** - A **perineal butterfly hematoma** is more characteristic of an injury to the **anterior urethra**, specifically the bulbar urethra, often caused by a straddle injury. - It occurs due to the extravasation of blood into the subcutaneous tissue of the perineum, outlining the shape of a butterfly. *blood at the meatus* - **Blood at the meatus** is a classic sign of urethral injury, regardless of the segment (anterior or posterior). - It indicates disruption of the urethral mucosa and bleeding from the damaged blood vessels. *Retention of urine* - **Retention of urine** can occur due to either a complete or partial urethral transection, preventing normal urine flow. - The inability to void can lead to bladder distension and is a significant symptom in assessing urethral trauma severity. *Pelvic fracture* - **Pelvic fractures** are frequently associated with **membranous urethral injuries** because the membranous urethra is fixed within the pelvic ring. - Shear forces from pelvic trauma can cause the prostatomembranous junction to avulse.
Question 1152: A high-riding prostate is indicative of which injury?
- A. Extraperitoneal Bladder rupture
- B. Intraperitoneal Bladder Rupture
- C. Membranous Urethral Injury (Correct Answer)
- D. Bulbar Urethral Injury
Explanation: ***Membranous Urethral Injury*** - A **high-riding prostate** is a classic sign of **membranous urethral injury**, often resulting from **pelvic fractures**. - The disruption of the **urethra** above the perineal membrane causes the prostate to be displaced superiorly and appear "high." *Extraperitoneal Bladder rupture* - This typically occurs with **pelvic fractures** and involves urine leaking into the **retropubic space**. - While associated with pelvic trauma, it does not directly cause a high-riding prostate; the bladder itself may be ruptured, but the relative position of the prostate is not significantly altered. *Intraperitoneal Bladder Rupture* - This type of rupture usually results from a direct blow to a **full bladder** and involves urine extravasating into the **peritoneal cavity**. - It does not cause a high-riding prostate, as the injury is to the dome of the bladder, not the structures supporting the prostate. *Bulbar Urethral Injury* - A **bulbar urethral injury** usually results from a **straddle injury** and is located in the anterior urethra. - This type of injury does not affect the anatomical position of the prostate, which is posterior and superior to the bulbar urethra.
Question 1153: Prostate cancer that is limited to the capsule and not the urethra would be staged as -
- A. T1
- B. T2 (Correct Answer)
- C. T3
- D. T0
Explanation: ***T2*** - A T2 stage indicates that the prostate cancer is **confined within the prostate capsule**, meaning it has not spread beyond the outer layer of the prostate gland. - While it is not limited to the urethra, the key defining characteristic of T2 is **capsular confinement**, which is described in the question. *T1* - T1 stage prostate cancer is typically **non-palpable** on digital rectal exam (DRE) and not visible on imaging. - It is often found incidentally, for example, during a **transurethral resection of the prostate (TURP)** for benign prostatic hyperplasia. *T3* - A T3 stage indicates that the prostate cancer has **extended beyond the prostate capsule**, but has not metastasized to distant sites. - This typically involves invasion into the **seminal vesicles** or other periprostatic tissues. *T0* - T0 means there is **no evidence of primary tumor**, which is not consistent with a diagnosed prostate cancer. - This staging is used when there is no measurable tumor.
Question 1154: 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?
- A. External beam radiation therapy
- B. Androgen deprivation therapy (ADT)
- C. Active surveillance
- D. Surgical removal of the prostate (Radical prostatectomy) (Correct Answer)
Explanation: ***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 1155: What is the appropriate management for a patient with a carcinoid tumor of the appendix larger than 2 cm?
- A. Right hemicolectomy (Correct Answer)
- B. Appendicectomy
- C. Appendicectomy + abdominal CT scan
- D. Appendicectomy + 24 hrs urinary HIAA
Explanation: ***Right hemicolectomy*** - Carcinoid tumors of the appendix larger than **2 cm** are considered at high risk for **lymph node metastasis** and recurrence. - A **right hemicolectomy** provides adequate margins and allows for lymph node dissection, which is essential for staging and definitive treatment in such cases. *Appendicectomy* - An **appendicectomy** alone is typically sufficient for carcinoid tumors of the appendix that are **less than 1 cm** and localized to the tip. - For larger tumors, appendicectomy carries an unacceptably high risk of **incomplete resection** and metastatic disease. *Appendicectomy + abdominal CT scan* - While an **abdominal CT scan** is useful for assessing local spread and distant metastases, it does not address the need for a more extensive surgical resection for a **large primary tumor**. - A simple **appendicectomy** in this scenario would be inadequate as definitive treatment. *Appendicectomy + 24 hrs urinary HIAA* - **24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA)** is a biomarker used to detect and monitor **carcinoid syndrome**, which occurs in a minority of patients with carcinoid tumors. - Measuring 5-HIAA is primarily for assessing systemic symptoms rather than determining the primary surgical management of the **tumor size**.
Question 1156: A 25 year old male is receiving conservative management for an appendicular mass since 3 days now presents with a rising pulse rate, tachycardia and fever. The mode of management must be -
- A. Proceed to laparotomy and appendicectomy (Correct Answer)
- B. Intravenous antibiotics
- C. Continue Ochsner Sherren regimen with close monitoring
- D. Continue conservative management
Explanation: ***Proceed to laparotomy and appendicectomy*** - A **rising pulse rate, tachycardia, and fever** indicate **worsening sepsis** or **perforation** of the appendicular mass, necessitating urgent surgical intervention. - Continuing conservative management in the face of these signs carries a high risk of **morbidity and mortality** from peritonitis or widespread sepsis. *Continue Ochsner Sherren regimen with close monitoring* - The Ochsner Sherren regimen is a **conservative approach** for a stable appendicular mass, which is no longer the case with signs of deterioration. - **Clinical worsening** (tachycardia, rising fever, increased pulse) signifies failure of conservative management and requires a shift to surgical intervention. *Continue conservative management* - Continuing conservative management despite **signs of deterioration** (rising pulse, tachycardia, fever) would lead to further progression of the disease and potential life-threatening complications. - These symptoms suggest that the infection is **not contained** and is likely spreading, indicating the need for immediate surgical treatment. *Intravenous antibiotics* - While intravenous antibiotics are part of the initial conservative management, they are **insufficient** alone for an appendicular mass showing signs of deterioration. - The worsening clinical picture suggests a **failed antibiotic response** or a more severe underlying issue (e.g., abscess rupture) that requires surgical drainage or removal.
Question 1157: Under what guidelines is treatment started for a patient presenting with appendicular mass on a CT scan?
- A. Ochsner Sherren Regimen (Correct Answer)
- B. Conservative management and discharge
- C. Kocher's Regimen
- D. Immediate Laparotomy
Explanation: ***Ochsner Sherren Regimen*** - The **Ochsner Sherren regimen** is a conservative management approach specifically used for patients presenting with an **appendicular mass** (a palpable mass formed by the inflamed appendix, omentum, and small bowel loops). - This regimen involves **nil by mouth**, **intravenous fluids**, **antibiotics**, and **analgesia**, with close observation to allow the inflammation to subside before potential interval appendectomy. *Conservative management and discharge* - While the Ochsner Sherren regimen is a form of conservative management, simply stating "conservative management and discharge" is incomplete and potentially dangerous for a patient with an **appendicular mass**. - **Discharge** is not appropriate without a period of observation and specific medical interventions like antibiotics, as there's a risk of abscess formation or perforation. *Kocher's Regimen* - **Kocher's regimen** is not a recognized treatment protocol for an appendicular mass. - The term "Kocher" is more commonly associated with a **surgical incision** (Kocher incision for cholecystectomy) or a **maneuver** (Kocher maneuver for duodenal mobilization). *Immediate Laparotomy* - **Immediate laparotomy** is generally contraindicated in the presence of a well-formed **appendicular mass**. - Operating on a friable, inflamed mass can disrupt the natural containment, leading to widespread peritonitis and increased morbidity. The Ochsner Sherren regimen aims to cool down the inflammation first.
Question 1158: Treatment of choice for mucinous carcinoma of the gall bladder in the early stage is -
- A. Simple cholecystectomy (Correct Answer)
- B. Extended cholecystectomy
- C. Cholecystectomy with wedge resection of liver
- D. Chemotherapy only
Explanation: ***Simple cholecystectomy*** - For **early-stage (T1a) mucinous carcinoma of the gallbladder**, **simple cholecystectomy** is the treatment of choice - T1a disease (tumor confined to mucosa) has an excellent prognosis with **5-year survival >90%** after simple cholecystectomy alone - Extended resection offers **no survival benefit** for T1a disease and increases surgical morbidity - If incidentally discovered post-cholecystectomy with negative margins, no further surgery is needed *Extended cholecystectomy* - **Extended cholecystectomy** (cholecystectomy + liver segments IVb/V resection + portal lymphadenectomy) is indicated for **T2 or higher stage** disease (tumor invading muscularis propria or beyond) - This is **not** the treatment for early-stage disease as it increases morbidity without survival benefit - Reserved for more advanced tumors with deeper invasion *Cholecystectomy with wedge resection of liver* - This describes a component of extended cholecystectomy and is similarly indicated for **T2+ disease**, not early-stage - Wedge resection aims to achieve negative margins when tumor extends beyond the gallbladder wall - Not appropriate for early-stage mucinous carcinoma confined to mucosa *Chemotherapy only* - **Chemotherapy alone** is not curative for early-stage gallbladder carcinoma - Surgery remains the primary curative treatment for resectable disease - Chemotherapy is reserved for advanced, metastatic, or unresectable disease as palliative treatment
Question 1159: What is the primary indication for the Nigro Regimen?
- A. Anal Carcinoma (Correct Answer)
- B. Rectal Carcinoma
- C. Sigmoid Colon Carcinoma
- D. Duodenal Carcinoma
Explanation: ***Anal Carcinoma*** - The **Nigro Regimen** is a standard treatment protocol involving concurrent **chemotherapy** (5-fluorouracil and mitomycin C) and **radiation therapy** for anal carcinoma. - Its primary goal is to achieve **organ preservation** and avoid the need for abdominoperineal resection, which would result in a permanent colostomy. *Rectal Carcinoma* - Treatment for **rectal carcinoma** often involves surgery (e.g., low anterior resection), radiation, and chemotherapy, but the specific **Nigro Regimen** is not the primary protocol. - While some chemotherapy drugs might overlap, the combined regimen and indications are distinct. *Sigmoid Colon Carcinoma* - **Sigmoid colon carcinoma** is typically treated primarily with **surgical resection**, often followed by adjuvant chemotherapy based on staging. - The Nigro Regimen is specifically designed for tumors in the **anal canal**, not the more proximal colon. *Duodenal Carcinoma* - **Duodenal carcinoma** is a rare gastrointestinal cancer usually managed with surgical resection, such as a **Whipple procedure**, and sometimes adjuvant chemotherapy. - This type of cancer is anatomically and etiologically distinct from anal carcinoma, making the Nigro Regimen irrelevant.