NEET-PG 2015 Practice Questions

Q: Most common acute complication of dialysis is

Hypotension. ***Hypotension*** - **Intradialytic hypotension** is the most common acute complication, occurring in 15-30% of dialysis sessions. - It is often caused by rapid removal of fluid (ultrafiltration), leading to a significant drop in blood pressure [1]. *Bleeding* - While bleeding can occur due to **anticoagulation** used during dialysis or as a complication of vascular access, it is less common than hypotension. - It is not considered the most frequent acute complication of the dialysis procedure itself. *Dementia* - **Dementia** is a chronic neurological condition that is not an acute complication directly attributable to a single dialysis session. - It can be a long-term comorbidity in patients with end-stage renal disease (ESRD), but not an immediate side effect. *Muscle cramps* - **Muscle cramps** are a relatively common acute complication during or immediately after dialysis, affecting about 5-20% of patients. - However, their frequency is generally lower than that of intradialytic hypotension [1].

Q: A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -

Antinuclear antibody. ***Antinuclear antibody*** - The constellation of **myalgias**, **pleural effusion**, **pericarditis**, and **arthralgias without joint deformity** is highly suggestive of **systemic lupus erythematosus (SLE)**. - **Antinuclear antibodies (ANA)** are present in over 95% of patients with SLE and are the primary screening test for this condition [1]. *CD4/CD8 lymphocyte count* - This count is more relevant for monitoring **immunodeficiency** conditions like **HIV infection**, where it helps assess immune status. - While lymphocytes can be affected in autoimmune diseases, a CD4/CD8 count is not a primary screening test for SLE. *Erythrocyte sedimentation rate* - An **elevated ESR** indicates general inflammation and is a **non-specific marker** [2]. - While it is often elevated in SLE, it doesn't confirm the diagnosis and can be high in numerous other inflammatory conditions [1]. *Assay for thyroid hormones* - An assay for thyroid hormones is used to diagnose **thyroid disorders** like **hypothyroidism** or **hyperthyroidism**. - There is no direct link between thyroid hormone levels and the symptoms described in the patient.

Q: Medial snapping knee syndrome is due to involvement of -

Pes Anserinus. ***Pes Anserinus*** - The **pes anserinus bursa** and its associated tendons (sartorius, gracilis, semitendinosus) can cause medial knee pain and snapping if inflamed or irritated. - This is a common cause of **medial snapping knee syndrome**, particularly in athletes or individuals with valgus deformity. *Quadriceps Tendon* - The **quadriceps tendon** is located anteriorly, connecting the quadriceps muscles to the patella, and is not typically involved in medial snapping. - Issues with the quadriceps tendon usually present as anterior knee pain or tendinitis. *Gastrocnemius origin* - The **gastrocnemius origin** is at the distal femur and its involvement would typically cause posterior knee pain or symptoms related to calf muscle function. - It does not commonly cause medial knee snapping. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** is on the lateral side of the knee and its involvement would cause lateral knee pain or instability. - It is not associated with medial snapping knee syndrome.

Q: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Hemiarthroplasty. ***Hemiarthroplasty*** - For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency. - This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures. *Excision arthroplasty* - **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable. - It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment. *Closed reduction and fixation with three cancellous screws* - This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis. - In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental. *Longitudinal skin traction for 6 weeks* - Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**. - It does not provide definitive fixation and is not a definitive treatment for a bony fracture.

Q: Which of the following is NOT a symptom of Kwashiorkor?

Hypertension. ***Hypertension*** - **Hypertension** is generally **NOT a direct symptom** of Kwashiorkor; rather, children with Kwashiorkor often have **low blood pressure** due to overall cardiovascular system depression. - While chronic malnutrition can have various systemic effects, elevated blood pressure is not a characteristic clinical feature of this condition. - This is the correct answer as the question asks what is NOT a symptom. *Hair changes and depigmentation* - This is a **classic symptom** of Kwashiorkor, characterized by sparse, brittle hair that may be discolored (e.g., reddish or yellowish - "flag sign"). - These changes reflect the severe protein deficiency interfering with hair follicle function and melanin production. *Edema* - **Edema**, particularly in the lower extremities and face, is a **hallmark symptom** of Kwashiorkor, caused by severe protein deficiency leading to decreased oncotic pressure. - This results in fluid shifting from the intravascular space into the interstitial space. *Growth retardation* - **Growth retardation** (stunting) is a common and severe symptom of Kwashiorkor, reflecting the long-term impact of inadequate protein and energy intake on physical development. - Both height and weight are significantly below age-appropriate norms.

Q: Which of the following is used to decrease the duration and severity of acute diarrhea?

Zn. ***Zn*** - **Zinc supplementation** has been shown to reduce the **duration** and **severity** of acute diarrhea, particularly in children in developing countries [1]. - It plays a crucial role in **immune function** and **intestinal integrity**, which helps in recovery from diarrheal episodes [1]. *Mg* - **Magnesium** is an essential mineral, but it is not directly used to decrease the duration or severity of acute diarrhea. - In fact, high doses of magnesium can act as a **laxative** and may worsen diarrhea. *Fe* - **Iron** is vital for red blood cell formation and oxygen transport, but it does not directly impact the duration or severity of acute diarrhea. - Iron supplementation is primarily used to treat **anemia**. *Ca* - **Calcium** is important for bone health and various metabolic processes, but it is not a primary intervention for reducing the duration or severity of acute diarrhea. - While sometimes used for mild digestive issues, it does not have the same evidence base as zinc for acute diarrhea.

Q: In which of the following cancers is intraoperative radiotherapy (IORT) applicable?

All of the options. ***All of the options*** - **Intraoperative radiotherapy (IORT)** is applicable to all three cancers listed: gastric cancer, colon carcinoma, and pancreatic carcinoma. - IORT is a technique where a **single, high dose of radiation** is delivered to the tumor bed during surgery to improve local control and reduce late toxicity to surrounding healthy tissues. - All three cancers benefit from IORT due to their **high risk of local recurrence** and the ability to directly target the tumor bed while sparing adjacent critical organs. **Gastric cancer:** - IORT addresses **high rates of local recurrence** after conventional surgery, especially in locally advanced stages - Allows direct radiation of potentially involved regional lymph nodes or margins difficult to eradicate surgically - Particularly useful when complete surgical clearance carries excessive morbidity risk **Colon carcinoma:** - IORT considered in **locally advanced or recurrent disease**, particularly when tumors invade adjacent structures - Beneficial after resections with positive or close margins - Delivers high dose to microscopic residual disease in the tumor bed, avoiding damage to vital organs from external beam radiotherapy **Pancreatic carcinoma:** - High propensity for **local invasion and recurrence** makes IORT particularly relevant - Delivers high dose directly to tumor bed following resection when microscopic residual disease is suspected - Overcomes limitations of external beam radiation due to proximity of critical organs (duodenum, stomach, kidneys)

Q: A child presented with blunt abdominal trauma, the first investigation to be done is -

USG. ***USG*** - An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability. - **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**. - It is the **preferred initial investigation in hemodynamically stable pediatric patients**. *CT Scan* - A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children. - It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients. *Complete Hemogram* - A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**. - While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**. *Abdominal X-ray* - An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures. - It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.

Q: CA Breast may locally spread to all of the following muscles except

Latissimus Dorsi. ***Latissimus Dorsi*** - The **latissimus dorsi** muscle is located on the posterior aspect of the trunk and arm, significantly deeper and further away from the breast tissue compared to other surrounding muscles. - Direct local invasion of breast cancer to the latissimus dorsi is rare and typically requires extensive tumor growth or metastasis to more distant sites before affecting this muscle. *Pectoralis Minor* - The **pectoralis minor** muscle lies directly beneath the pectoralis major and is in close proximity to the deeper aspects of the breast tissue. - Tumors that invade the **deep fascia** of the breast can directly extend into this muscle. *Serratus Anterior* - The **serratus anterior** muscle is located on the lateral wall of the thorax, forming part of the chest wall beneath the breast. - **Aggressive breast cancers**, particularly those in the outer quadrants, can invade the fascial planes covering this muscle. *Pectoralis Major* - The **pectoralis major** forms the anterior wall of the axilla and lies directly beneath the majority of the breast tissue. - It is one of the most common muscles to be affected by **direct local invasion** from breast cancer due to its anatomical proximity.

Question 1

Most common acute complication of dialysis is

Accepted Answer

Hypotension

Answer

Bleeding

Answer

Dementia

Answer

Muscle cramps

Question 2

A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -

Accepted Answer

Antinuclear antibody

Answer

Erythrocyte sedimentation rate

Answer

Assay for thyroid hormones

Answer

CD4/CD8 lymphocyte count

Question 3

All are true about uteroplacental circulation except:

Accepted Answer

A mature placenta has 150 ml of blood in the villi system and 350 ml of blood in the intervillous space

Answer

The villi depend on the maternal blood for their nutrition

Answer

Blood in the intervillous space is completely replaced 3-4 times per minute

Answer

Intervillous blood flow at term is 500-600 ml per minute

Question 4

Medial snapping knee syndrome is due to involvement of -

Accepted Answer

Pes Anserinus

Answer

Gastrocnemius origin

Answer

Lateral collateral ligament

Answer

Quadriceps Tendon

Question 5

Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Accepted Answer

Hemiarthroplasty

Answer

Closed reduction and fixation with three cancellous screws

Answer

Longitudinal skin traction for 6 weeks

Answer

Excision arthroplasty

Question 6

Which of the following is NOT a symptom of Kwashiorkor?

Accepted Answer

Hypertension

Answer

Hair changes and depigmentation

Answer

Edema

Answer

Growth retardation

Question 7

Which of the following is used to decrease the duration and severity of acute diarrhea?

Accepted Answer

Zn

Answer

Mg

Answer

Fe

Answer

Ca

Question 8

In which of the following cancers is intraoperative radiotherapy (IORT) applicable?

Accepted Answer

All of the options

Answer

Gastric cancer

Answer

Colon carcinoma

Answer

Pancreatic carcinoma

Question 9

A child presented with blunt abdominal trauma, the first investigation to be done is -

Accepted Answer

USG

Answer

CT Scan

Answer

Complete Hemogram

Answer

Abdominal X-ray

Question 10

CA Breast may locally spread to all of the following muscles except

Accepted Answer

Latissimus Dorsi

Answer

Pectoralis Minor

Answer

Serratus Anterior

Answer

Pectoralis Major

NEET-PG 2015

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Radiology

Surgery