NEET-PG 2015 Practice Questions

Q: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:

Serum GGT. ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.

Q: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:

Splenic Vein Thrombosis. ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.

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: Which of the following testicular tumours is NOT a germ cell tumour?

Sertoli cell tumour. ***Sertoli cell tumour*** - This is a **sex-cord stromal tumour**, not a germ cell tumour, hence it does not arise from germ cells. - Sertoli cell tumours typically present with abnormal hormone levels, but not the classic germ cell tumour markers. *Choriocarcinoma* - This is a **germ cell tumour** that is aggressive and associated with high levels of **beta-hCG** [1][2]. - It derives from the placental tissue and is characterized by **trophoblastic differentiation** [2]. *Seminoma* - A well-known type of **germ cell tumour**, often presenting as a **homogeneous testicular mass** [1]. - It usually manifests with elevated **LDH** and is associated with a more favorable prognosis compared to non-seminomatous germ cell tumours [1]. *Teratoma* - Teratomas are also classified as **germ cell tumours**, containing differentiated tissues like hair, muscle, and bone [1][2]. - They can be **mature** (benign) or **immature** (malignant), and are typically found in younger patients [2][3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 982-983. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.

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.

Q: A 45-year-old female underwent a modified radical mastectomy with axillary clearance for breast cancer. Post-surgery, she is unable to lift her arm above her head. Which nerve is most likely to be injured?

Long thoracic nerve of Bell. ***Long thoracic nerve of Bell*** - Injury to the **long thoracic nerve** (nerve to the serratus anterior) leads to **paralysis of the serratus anterior muscle**. - This muscle is crucial for **upward rotation and protraction of the scapula**, which is essential for arm elevation above the head and preventing **'winging' of the scapula**. *Intercostobrachial nerve* - Injury to the **intercostobrachial nerve** typically causes **sensory loss** or numbness in the medial upper arm. - It does not primarily affect motor function or the ability to lift the arm. *Nerve to latissimus Dorsi* - The **thoracodorsal nerve** innervates the **latissimus dorsi muscle**, which is involved in adduction, extension, and internal rotation of the arm. - Injury to this nerve would impair these movements but not directly prevent arm elevation above the head. *Lateral Pectoral nerve* - The **lateral pectoral nerve** supplies the **pectoralis major muscle**, primarily its clavicular head. - Injury would weaken adduction and flexion of the arm, but the inability to lift the arm above the head strongly points to serratus anterior dysfunction.

Q: A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is

Fibroadenoma. ***Fibroadenoma*** - This is the most common benign breast tumor in young women, typically presenting as a **mobile, non-tender, firm mass** with no attachment to surrounding tissues. - The history of a **non-progressive mass** over six months in a 22-year-old woman is highly characteristic of a fibroadenoma. *Cystasarcoma Phylloides* - While it can present as a mobile mass, phyllodes tumors tend to grow **rapidly** and can reach a large size, which contradicts the "non-progressive" nature of the mass described. - Phyllodes tumors often have a **leaf-like architectural pattern** histologically and can be benign, borderline, or malignant. *Scirrhous Carcinoma* - This is a type of invasive ductal carcinoma that typically presents as a **hard, irregular, fixed mass** that is often attached to the skin or underlying tissue, unlike the mobile mass described here. - It is common in older women and often associated with **skin dimpling** or nipple retraction. *Fibroadenosis* - This refers to a group of benign breast changes, often presenting with generalized **lumpiness, pain, or tenderness** that fluctuates with the menstrual cycle, rather than a discrete, solitary mass. - It usually presents as **multiple, diffuse nodules** rather than a single, well-defined mass.

Q: RPLND and Chemotherapy may be used in management of?

Non-seminomatous germ cell tumors of the testis. ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.

Q: The Grayhack shunt is established between which of the following?

Corpora cavernosa and saphenous vein. ***Corpora cavernosa and saphenous vein*** - The **Grayhack shunt** is a proximal **cavernosal-venous shunt** that connects the corpus cavernosum to the **great saphenous vein**. - This procedure surgically manages **refractory priapism** by diverting blood away from the trapped penile cavernosal spaces into the systemic venous circulation. - It is performed when distal and proximal corporeal shunts have failed. *Corpora cavernosa and dorsal vein* - This describes the **Barry shunt**, which connects the corpus cavernosum to the **deep dorsal vein**. - The Al-Ghorab shunt (sometimes confused) is actually a **distal corporo-glanular shunt** involving open excision of glans tissue — not a dorsal vein shunt. *Corpora cavernosa and glans* - This describes **distal cavernosal-glanular shunts** such as the **Winter shunt** (percutaneous needle) or **Ebbehoj shunt** (scalpel incision), which create a communication between the corpus cavernosum and the glans penis. - These are **first-line** surgical options for priapism but are distinct from the proximal Grayhack shunt. *Corpora cavernosa and corpora spongiosa* - This describes the **Quackels shunt**, a **proximal cavernosal-spongiosal shunt** connecting the corpora cavernosa to the corpus spongiosum. - Also used for refractory priapism, but anatomically and surgically distinct from the Grayhack (cavernosal-venous) shunt.

Q: Which of the following statements about undescended testis is true?

Increased risk of malignancy. ***Increased risk of malignancy*** - Undescended testis is associated with a **3 to 14 times increased risk** of testicular malignancy, particularly **seminoma**. - The risk remains elevated even after orchiopexy, though the procedure allows for **easier surveillance and examination**. - This is one of the **most important clinical features** of cryptorchidism and a key reason for early surgical correction. - Even a **corrected cryptorchid testis** maintains higher cancer risk compared to normally descended testes. *Secondary sexual characteristics are universally normal* - In **unilateral cryptorchidism** (90% of cases), the normally descended contralateral testis produces **adequate testosterone** for normal secondary sexual development. - However, in **bilateral cryptorchidism** or if the descended testis is functionally impaired, **testosterone deficiency** can occur, leading to delayed or abnormal sexual development. - Therefore, secondary sexual characteristics are **not universally normal** in all cases of undescended testis. *Hormonal therapy is effective* - Hormonal therapy with **hCG (human chorionic gonadotropin)** or **GnRH (gonadotropin-releasing hormone)** has **limited and inconsistent effectiveness**. - Success rates are generally **low** (10-30%), particularly for truly undescended testes (as opposed to retractile testes). - **Orchiopexy** (surgical correction) remains the **definitive treatment**, ideally performed between **6-18 months of age** to optimize fertility potential. *More common on the right side* - Undescended testis is actually **slightly more common on the left side** (~55-60%) than the right (~40-45%). - **Bilateral cryptorchidism** occurs in approximately 10-20% of cases. - There is no significant right-sided predilection.

Question 1

A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:

Accepted Answer

Serum GGT

Answer

Serum LDH

Answer

Base deficit

Answer

Age

Question 2

A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:

Accepted Answer

Splenic Vein Thrombosis

Answer

Bleeding

Answer

Gastric Outlet Obstruction

Answer

Perforation

Question 3

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 4

Which of the following testicular tumours is NOT a germ cell tumour?

Accepted Answer

Sertoli cell tumour

Answer

Seminoma

Answer

Teratoma

Answer

Choriocarcinoma

Question 5

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

Question 6

A 45-year-old female underwent a modified radical mastectomy with axillary clearance for breast cancer. Post-surgery, she is unable to lift her arm above her head. Which nerve is most likely to be injured?

Accepted Answer

Long thoracic nerve of Bell

Answer

Intercostobrachial nerve

Answer

Nerve to latissimus Dorsi

Answer

Lateral Pectoral nerve

Question 7

A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is

Accepted Answer

Fibroadenoma

Answer

Cystasarcoma Phylloides

Answer

Scirrhous Carcinoma

Answer

Fibroadenosis

Question 8

RPLND and Chemotherapy may be used in management of?

Accepted Answer

Non-seminomatous germ cell tumors of the testis

Answer

Non-germ cell tumors

Answer

Seminomatous germ cell tumors

Answer

Lymphoma of the testis

Question 9

The Grayhack shunt is established between which of the following?

Accepted Answer

Corpora cavernosa and saphenous vein

Answer

Corpora cavernosa and dorsal vein

Answer

Corpora cavernosa and glans

Answer

Corpora cavernosa and corpora spongiosa

Question 10

Which of the following statements about undescended testis is true?

Accepted Answer

Increased risk of malignancy

Answer

Hormonal therapy is effective

Answer

More common on the right side

Answer

Secondary sexual characteristics are universally normal

NEET-PG 2015

Internal Medicine

Pathology

Surgery