NEET-PG 2015 Practice Questions

Q: Most common cause of goiter in India is

Diffuse Endemic Goitre. ***Diffuse Endemic Goitre*** - **Iodine deficiency** is the leading cause of goiter globally, particularly in areas with poor iodine intake like some regions in India, leading to **diffuse endemic goiter** - In response to low iodine, the thyroid gland undergoes **hypertrophy** and **hyperplasia**, increasing in size in an attempt to capture more iodine for thyroid hormone synthesis - Despite the **Universal Salt Iodization (USI) program**, iodine deficiency disorders remain a significant public health concern in several Indian states *Papillary Carcinoma* - While it can cause a thyroid mass, **papillary carcinoma** is a malignant neoplastic condition, not the most common cause of generalized goiter - It presents as a **solitary or dominant nodule** and is not typically associated with widespread iodine deficiency - Accounts for only a small percentage of thyroid enlargements *Toxic Multinodular Goitre* - This condition involves multiple autonomously functioning nodules and primarily causes **hyperthyroidism**, not just goiter as a primary common presentation - More common in **elderly patients** and in regions with prior iodine deficiency (Jod-Basedow phenomenon) - Does not represent the most widespread cause of goiter in the general population of India *Hashimoto's Thyroiditis* - Hashimoto's is an **autoimmune disease** causing chronic lymphocytic thyroid inflammation and often hypothyroidism - While it can cause goiter, it typically produces a **firmer, less diffuse enlargement** than that seen with **iodine deficiency** - Not the most common cause of goiter in India, though its prevalence is increasing in urban areas

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: A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is

Solitary Toxic Adenoma. A **solitary toxic adenoma** is a single thyroid nodule that autonomously produces thyroid hormones, leading to **hyperthyroidism**. The increased iodine uptake on scan reflects its hyperfunctional state, and elevated **T3/T4** confirms hyperthyroidism. [2] - The combination of a **solitary nodule**, **increased iodine uptake**, and **elevated thyroid hormone levels** is pathognomonic for a solitary toxic adenoma. [2] *Benign Thyroid Nodule* - A **benign thyroid nodule** without hyperfunction would typically show **normal or decreased iodine uptake** and **normal T3/T4** levels. [2] - While benign, such a nodule alone does not explain the **elevated T3/T4** or **increased iodine uptake**. *Follicular Carcinoma* - **Follicular carcinoma** is a type of thyroid cancer that typically presents as a **cold nodule** (decreased iodine uptake) and is usually **non-functional**, meaning it does not cause hyperthyroidism with elevated T3/T4. [2] - The presence of **increased iodine uptake** and **hyperthyroidism** makes follicular carcinoma highly unlikely. *Toxic Multinodular Goiter* - A **toxic multinodular goiter** involves **multiple nodules**, not a solitary one, that are autonomously functional and cause hyperthyroidism. [1] - While it causes **hyperthyroidism** and **increased iodine uptake**, the key differentiating factor here is the presentation as a **solitary nodule**.

Q: All of the following may lead to pneumatocele formation except which of the following?

ARDS. ***ARDS*** - **Acute Respiratory Distress Syndrome (ARDS)** is primarily characterized by **inflammatory lung injury**, leading to **alveolar edema**, but does not typically cause pneumatocele formation [1]. - Pneumatoceles are more likely associated with infections or mechanical ventilation, not with ARDS itself. *Staphylococcal pneumonia* - **Staphylococcal pneumonia** can lead to pneumatocele formation due to **necrotizing pneumonia**, where the formation of air-filled cysts occurs from lung tissue damage. - This type of pneumonia is associated with **Staphylococcus aureus** and can cause cavitary lesions. *Positive pressure ventilation* - **Positive pressure ventilation** can increase the risk of barotrauma, leading to the formation of pneumatocele through excess air entering lung tissue. - It is often used in cases of respiratory distress but can inadvertently contribute to pneumatocele development. *Hydrocarbon inhalation* - **Hydrocarbon inhalation** is linked to pneumonitis and can cause lung injury, leading to the formation of **pneumatoceles** as a result of **lung inflammation**. - Such inhalation can create **alveolar damage**, allowing for air-filled spaces to develop.

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: 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.

Q: Which of the following statements about Branchial cysts is true:

Most common site is lateral neck. ***Most common site is lateral neck*** - **Branchial cleft cysts** typically present as a mass in the **lateral neck**, anterior to the sternocleidomastoid muscle. - They are congenital anomalies resulting from incomplete obliteration of the branchial clefts during embryonic development. *50-70% are seen in lungs* - This statement is incorrect; branchial cysts are **cervical anomalous masses** arising from the branchial apparatus, not primarily found in the lungs. - Lung lesions are more commonly associated with congenital pulmonary airway malformations or bronchogenic cysts, which differ in origin. *They are premalignant lesions* - Branchial cysts are generally **benign lesions** and do not typically transform into malignancy. - While rare cases of carcinoma arising within a branchial cleft cyst have been reported, they are not considered routinely premalignant. *Infection is uncommon in branchial cysts* - Conversely, infection is a **common complication** of branchial cysts, often leading to sudden enlargement, pain, and erythema. - The presence of internal fluid and epithelial lining makes them susceptible to bacterial colonization and subsequent abscess formation.

Q: A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?

Tension Pneumothorax. ***Tension Pneumothorax*** - The classic triad of **breathlessness**, **decreased breath sounds** on the affected side, and **hyperresonance** on percussion following chest trauma is highly indicative of a tension pneumothorax. - **Distended neck veins** (jugular venous distension) occur due to increased intrathoracic pressure impeding venous return to the heart. *Cardiac Tamponade* - Characterized by **Beck's triad**: hypotension, muffled heart sounds, and jugular venous distension. - While **distended neck veins** are present, the absence of muffled heart sounds, the presence of decreased breath sounds, and hyperresonance point away from tamponade. *Flail Chest* - Defined by at least two contiguous ribs fractured in at least two places, leading to a **paradoxical movement** of the chest wall during respiration. - The key diagnostic feature of flail chest (paradoxical chest wall movement) is not described, nor are the breath sounds or percussion findings consistent with this diagnosis. *Myocardial Infarction* - Typically presents with **sudden chest pain**, often radiating to the left arm or jaw, and may cause breathlessness. - It does not cause **decreased breath sounds**, **hyperresonance**, or directly lead to these specific localized chest findings after trauma.

Q: Which of the following stages of lip carcinoma does not have nodal involvement?

T3N0. ***T3N0*** - The **'N' classification** in the TNM staging system refers to **nodal involvement**. A stage with **'N0' indicates no regional lymph node metastasis**. - A **T3 lesion** signifies a large primary tumor, but if it's accompanied by **N0**, it means there's no evidence of spread to the lymph nodes. *T2N1* - The **'N1' classification** indicates the presence of **regional lymph node metastasis**, specifically in a **single ipsilateral lymph node** that is 3 cm or less in its greatest dimension. - This stage therefore **does have nodal involvement**, contradicting the premise of the question. *T2N2* - The **'N2' classification** signifies more advanced regional lymph node metastasis, such as a **single ipsilateral lymph node** greater than 3 cm but not more than 6 cm. - It could also refer to **multiple ipsilateral lymph nodes**, none greater than 6 cm, or bilateral/contralateral lymph nodes, none greater than 6 cm. In all these cases, **nodal involvement is present**. *T1N1* - Similar to T2N1, the **'N1' component** in T1N1 indicates the presence of **regional lymph node metastasis** in a single ipsilateral lymph node of 3 cm or less. - Therefore, this stage **does involve nodal spread**, despite having a smaller primary tumor (T1).

Question 1

Most common cause of goiter in India is

Accepted Answer

Diffuse Endemic Goitre

Answer

Papillary Carcinoma

Answer

Toxic Multinodular Goitre

Answer

Hashimoto's Thyroiditis

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

A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is

Accepted Answer

Solitary Toxic Adenoma

Answer

Benign Thyroid Nodule

Answer

Follicular Carcinoma

Answer

Toxic Multinodular Goiter

Question 4

All of the following may lead to pneumatocele formation except which of the following?

Accepted Answer

ARDS

Answer

Staphylococcal pneumonia

Answer

Positive pressure ventilation

Answer

Hydrocarbon inhalation

Question 5

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 6

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 7

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

Question 8

Which of the following statements about Branchial cysts is true:

Accepted Answer

Most common site is lateral neck

Answer

50-70% are seen in lungs

Answer

They are premalignant lesions

Answer

Infection is uncommon in branchial cysts

Question 9

A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Flail Chest

Answer

Myocardial Infarction

Answer

Cardiac Tamponade

Question 10

Which of the following stages of lip carcinoma does not have nodal involvement?

Accepted Answer

T3N0

Answer

T2N1

Answer

T2N2

Answer

T1N1

NEET-PG 2015

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Surgery