NEET-PG 2015 Practice Questions

Q: Food can commonly get obstructed in the esophagus at all of the following locations except

Crossing of the hemiazygous vein. Food can commonly get obstructed in the esophagus at all of the following locations except ***Crossing of the hemiazygous vein*** - The **hemiazygos vein crosses the vertebral column** at T7-T9 to drain into the azygos vein; however, this anatomical relationship does not typically create a constriction or point of obstruction for the esophagus. - While it is in proximity, its course does not physically compress or narrow the esophageal lumen in a manner that would commonly cause food impaction. *Crossing of left bronchus* - The **left main bronchus crosses anterior to the esophagus** at the level of the carina (T4-T5), causing a natural indentation and narrowing of the esophageal lumen. - This anatomical narrowing, coupled with the rigid structure of the bronchus, makes it a common site for food impaction, especially for larger boluses. *Crossing of arch of aorta* - The **arch of the aorta crosses anterior and to the left of the esophagus** at the level of T3-T4, creating another significant anatomical constriction. - This bending and compression by a large, typically pulsatile vessel forms a natural bottleneck where swallowed food can easily become lodged. *Diaphragmatic aperture* - The **esophageal hiatus of the diaphragm** (T10) is the most distal natural esophageal narrowing, where the esophagus passes through a muscular opening before joining the stomach. - This narrow opening, surrounded by the crura of the diaphragm, is a very common site for food impaction, particularly when the opening is physiologically or pathologically narrowed (e.g., in cases of hiatal hernia or tight diaphragmatic attachments).

Q: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Follicular adenoma. ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.

Q: Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?

Cervical intraepithelial Neoplasia. ***Cervical intraepithelial neoplasia (CIN)*** - CIN has a high success rate with treatment (e.g., **cryotherapy**, **LEEP**), often completely eradicating the dysplastic cells and preventing progression to **invasive cervical cancer**. - The effectiveness of screening via **Pap smears** allows for early detection and intervention, significantly reducing cancer risk. *Ductal carcinoma in situ (DCIS) of breast* - While treatable, DCIS carries a higher risk of recurrence and progression to **invasive breast cancer** in the same or contralateral breast compared to CIN. - Treatment often involves **lumpectomy** with or without radiation, and sometimes **total mastectomy**, reflecting its more serious potential. *Lobular carcinoma in situ (LCIS) of breast* - LCIS is largely considered a **risk indicator** for future invasive cancer in either breast, rather than a direct precursor that inevitably progresses. - Management often involves **close surveillance** or **chemoprevention**, as surgical excision does not prevent cancer development in other areas of the breast. *Vaginal intraepithelial neoplasia (VAIN)* - While treatable, VAIN is less common and often coexists with or follows **cervical or vulvar neoplasia**, indicating a broader field defect due to **HPV**. - Recurrence rates post-treatment can be significant, and patients often require long-term follow-up due to the continued risk of progression.

Q: Which of the following statements about MALToma is true?

H. Pylori infection is a known risk factor. ***H. Pylori infection is a risk factor*** - MALToma, or **mucosa-associated lymphoid tissue lymphoma**, is often associated with chronic **H. Pylori infection**, making it a significant risk factor [1]. - **Eradication of H. Pylori** can lead to regression of MALT lymphoma, further supporting the association. *They are a type of T cell lymphoma* - MALToma is classified as a **B-cell lymphoma**, primarily arising from **marginal zone B cells** [1]. - T-cell lymphomas differ significantly in their **pathophysiology** and typical clinical presentations. *They are secondary gastric lymphomas* - MALTomas typically arise **primarily** in the gastric mucosa rather than as secondary lymphomas from another site [1]. - Secondary lymphomas are usually related to more aggressive forms and are often associated with **systemic involvement**. *Commonly seen in gastric cardia* - MALTomas are most frequently found in the **stomach** but are not specifically concentrated in the **gastric cardia** region. - They can also manifest in other areas such as the **antrum**, making this statement misleading. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-358.

Q: In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?

Cholesterolosis of the gallbladder. ***Cholesterolosis of the gallbladder*** - This condition is characterized by the accumulation of **cholesterol esters** and **triglycerides** within macrophages in the lamina propria of the gallbladder, creating a **speckled appearance** often referred to as a "**strawberry gallbladder**". - It is typically asymptomatic but can be associated with **cholelithiasis** (gallstones) in some cases. *Gangrene of the gallbladder* - This is a severe complication of **acute cholecystitis** where the gallbladder tissue dies due to **ischemia**, often appearing necrotic and dark, not speckled. - It presents with severe abdominal pain, fever, and signs of **sepsis**, which is distinct from a speckled appearance. *Porcelain gallbladder* - This condition involves **extensive calcification of the gallbladder wall**, making it brittle and rigid, and is often associated with an increased risk of gallbladder cancer. - Its appearance is typically hard and white due to calcification, not speckled like a strawberry. *Adenomatosis of the gallbladder* - This term is often used interchangeably with **adenomyomatosis**, which involves **hypertrophy of the muscularis propria** and **outpouchings of the mucosa** (Rokitansky-Aschoff sinuses). - It presents as nodular or diffuse thickening of the gallbladder wall, not a speckled mucosal pattern.

Q: What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?

CT scan. ***CT scan*** - **CT scan** with contrast is the gold standard for diagnosing renal cell carcinoma and evaluating the extent of tumor thrombus into the **IVC**. - It provides detailed anatomical information on the tumor, staging, and involvement of adjacent structures. *Angiography* - **Angiography** is an invasive procedure primarily used for mapping the vascular supply of the tumor preoperatively or for embolization, not as a primary diagnostic tool. - It carries risks associated with contrast agents and catheterization and provides less comprehensive detail on tumor extension compared to CT. *Colour doppler imaging* - While useful for detecting blood flow and confirming the presence of a thrombus, **color Doppler imaging** (ultrasound) has limitations in accurately assessing the cranial extent of an IVC thrombus. - Its diagnostic accuracy is highly operator-dependent and less reliable for deep structures like the IVC compared to CT. *IVP* - **Intravenous Pyelogram (IVP)** assesses the urinary tract's structure and function but has limited utility in detecting soft tissue masses like renal cell carcinoma or IVC thrombus. - It involves radiation exposure and contrast material, and has largely been replaced by more advanced imaging techniques like CT and MRI for renal masses.

Q: An Incisional wound heals by

Primary Healing. ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.

Q: What is the commonest site of peptic ulcer?

First part of the duodenum. ***First part of the duodenum*** - The **duodenal bulb** (first part of the duodenum) is the most common location for peptic ulcers due to its proximity to the pylorus, where it's exposed to **acidic chyme** and susceptible to **H. pylori infection**. - The **mucosal defenses** in the duodenum are often less robust compared to the stomach, making it more vulnerable to acid-pepsin aggression. *Second part of the duodenum* - Ulcers in the **second part of the duodenum** are relatively rare compared to the first part. - This section receives bile and pancreatic secretions which help to **neutralize stomach acid**, providing greater protection. *Distal third of the stomach* - Ulcers in the **distal third of the stomach** are less common than in the first part of the duodenum. - While **gastric ulcers** do occur, they are more frequently found in the **antrum or lesser curvature** of the stomach. *Pylorus of the stomach* - Ulcers can occur in the **pylorus**, but they are not as frequent as those in the **duodenal bulb**. - Pyloric ulcers are considered a type of **gastric ulcer** and can be associated with gastric outlet obstruction.

Question 1

Food can commonly get obstructed in the esophagus at all of the following locations except

Accepted Answer

Crossing of the hemiazygous vein

Answer

Crossing of left bronchus

Answer

Crossing of arch of aorta

Answer

Diaphragmatic aperture

Question 2

Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Accepted Answer

Follicular adenoma

Answer

Multinodular goiter

Answer

Thyroid cyst

Answer

Follicular carcinoma

Question 3

Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?

Accepted Answer

Cervical intraepithelial Neoplasia

Answer

Ductal carcinoma in situ of breast

Answer

Lobular carcinoma in situ of breast

Answer

Vaginal intraepithelial neoplasia

Question 4

Which of the following statements about MALToma is true?

Accepted Answer

H. Pylori infection is a known risk factor

Answer

They are primary gastric lymphomas

Answer

They are a type of T cell lymphoma

Answer

Exclusively seen in the gastric antrum

Question 5

In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?

Accepted Answer

Cholesterolosis of the gallbladder

Answer

Gangrene of the gallbladder

Answer

Porcelain gallbladder

Answer

Adenomatosis of the gallbladder

Question 6

Which of the following is NOT a recognized cause of Urothelial Carcinomas?

Accepted Answer

Alcohol consumption

Answer

Industrial solvents

Answer

Exposure to thorotrast

Answer

Smoking

Question 7

What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?

Accepted Answer

CT scan

Answer

Angiography

Answer

Colour doppler imaging

Answer

IVP

Question 8

An Incisional wound heals by

Accepted Answer

Primary Healing

Answer

Secondary Healing

Answer

Epithelialization

Answer

Delayed primary Healing

Question 9

What is the commonest site of peptic ulcer?

Accepted Answer

First part of the duodenum

Answer

Second part of the duodenum

Answer

Distal third of the stomach

Answer

Pylorus of the stomach

Question 10

Which of the following statements accurately describes a subtotal thyroidectomy?

Accepted Answer

Removal of 1 lobe with isthmus and the second lobe partially

Answer

Removal of one lobe and isthmus

Answer

Removal of both lobes leaving behind 6-8 grams of tissue

Answer

Removal of entire thyroid with cervical lymphnodes

NEET-PG 2015

Anatomy

Internal Medicine

Obstetrics and Gynecology

Pathology

Radiology

Surgery