Anatomy
2 questionsMost common site for Cystic Hygroma is -
Transplanted kidney is relocated to which region in the recipient's body?
NEET-PG 2015 - Anatomy NEET-PG Practice Questions and MCQs
Question 961: Most common site for Cystic Hygroma is -
- A. Lower third of neck (Correct Answer)
- B. Overlying the parotid gland
- C. Along the Zygomatic Prominence
- D. Post auricular
Explanation: ***Lower third of neck*** - **Cystic hygromas** (also known as **lymphatic malformations**) most commonly occur in the **posterior triangle of the neck**, which is located in the lower lateral aspect of the neck [1]. - Approximately **75-80%** of cystic hygromas are found in the neck region, with the **posterior triangle** being the predominant site. - The **posterior jugular lymph sac** fails to connect properly with the venous system during embryonic development, leading to these cystic malformations in this characteristic location [1]. - The posterior triangle encompasses the lower lateral neck, making "lower third of neck" an acceptable description of this most common site. *Overlying the parotid gland* - While lymphatic malformations can occur in the parotid region, this represents only about **10-15%** of cases. - This is a less common site compared to the posterior triangle of the neck. - Lesions in this area might raise concern for other parotid pathologies like **pleomorphic adenoma** or **hemangioma**. *Along the Zygomatic Prominence* - This is an unusual location for a cystic hygroma, as the lymphatic drainage and embryonic development in this area are not typically associated with these malformations. - Lesions here might suggest different developmental or neoplastic etiologies such as **dermoid cysts** or **vascular malformations**. *Post auricular* - The post-auricular region is not a common site for cystic hygromas. - Swelling in this area could be due to other conditions like **mastoiditis**, **lymphadenopathy**, or **sebaceous cysts**.
Question 962: Transplanted kidney is relocated to which region in the recipient's body?
- A. Lumbar region
- B. Epigastrium
- C. Beside the dysfunctional kidney
- D. Retroperitoneal region (Correct Answer)
Explanation: ***Retroperitoneal region*** - The transplanted kidney is typically placed in the **iliac fossa** within the **retroperitoneal space** of the recipient [2]. - This location provides adequate space and a convenient site for connecting the transplant's renal artery and vein to the recipient's **iliac vessels**, and the ureter to the bladder [2]. *Lumbar region* - The native kidneys are located in the lumbar region, but a transplanted kidney is not usually placed there due to the complexity of vascular anastomoses and limited access [1]. - Positioning in the lumbar region would require more extensive surgical dissection and potentially longer vascular connections. *Epigastrium* - The epigastrium is the upper central part of the abdomen, above the navel. - This location is not suitable for kidney transplantation due to anatomical constraints and the lack of readily accessible large blood vessels for connection. *Beside the dysfunctional Kidney* - The dysfunctional native kidneys are usually left in place unless they are causing severe complications like uncontrolled hypertension or infection. - Placing the transplanted kidney directly beside the native dysfunctional kidney is not the standard procedure due to space limitations and to avoid operating near potentially diseased native organs.
Internal Medicine
1 questionsAll of the following are features of Zollinger Ellison syndrome except:
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 961: All of the following are features of Zollinger Ellison syndrome except:
- A. Severe diarrhoea
- B. Beta cell tumours of the pancreas (Correct Answer)
- C. Very high acid output
- D. Intractable peptic ulcers
Explanation: ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.
Surgery
7 questionsWhich of the following statements about heart transplantation is false?
What is the most common cause of lateral aberrant thyroid tissue?
A child presented with blunt abdominal trauma, the first investigation to be done is -
Vacuum assisted closure is contraindicated in which of the following conditions -
Which of the following statements is true regarding cystic hygroma?
The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:
Reactionary Hemorrhage occurs due to?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 961: Which of the following statements about heart transplantation is false?
- A. High pulmonary arterial resistance is a contraindication
- B. It is only orthotopic and not heterotopic (Correct Answer)
- C. Immunosuppression is started preoperatively
- D. A beating heart cadaver/donor is not always needed.
Explanation: ***It is only orthotopic and not heterotopic*** - This statement is **FALSE**, making it the correct answer to this question asking for the false statement. - While **orthotopic transplantation** (replacing the recipient's heart with the donor heart in its normal anatomical position) is the overwhelmingly predominant method, **heterotopic transplantation** (leaving the recipient's heart in place and implanting the donor heart as an auxiliary "piggyback" pump) has been performed as an alternative technique. - Heterotopic transplantation, though rarely used in modern practice, was described and performed in select cases, particularly when the donor heart is undersized or when severe pulmonary hypertension is present. Therefore, the claim that heart transplantation is "only orthotopic" is incorrect. *Immunosuppression is started preoperatively* - This statement is **TRUE**. - **Immunosuppressive therapy** is typically initiated intraoperatively or in some protocols may begin preoperatively to prevent hyperacute and acute rejection. - Induction immunosuppression aims to suppress the recipient's immune response before it can react to the transplanted organ, improving early graft survival. *High pulmonary arterial resistance is a contraindication* - This statement is **TRUE**. - **Fixed pulmonary hypertension** with elevated pulmonary vascular resistance (PVR >4-5 Wood units or transpulmonary gradient >15 mmHg unresponsive to vasodilators) is a **contraindication** for isolated heart transplantation. - The donor right ventricle may not be able to pump against high pulmonary pressures, leading to acute right heart failure. - Such patients may require combined heart-lung transplantation or medical optimization to reduce pulmonary vascular resistance before transplantation can be considered. *A beating heart cadaver/donor is not always needed* - This statement is considered **TRUE**, though with important caveats. - Traditionally, heart transplantation has relied almost exclusively on **beating-heart donors** (brain-dead donors with maintained cardiac function) to ensure organ viability. - The statement acknowledges that in rare circumstances or with advanced preservation techniques, the absolute requirement for a beating heart might be questioned, though in practical terms beating-heart donation remains the standard for heart transplantation.
Question 962: What is the most common cause of lateral aberrant thyroid tissue?
- A. Ectopic thyroid tissue due to developmental anomalies
- B. Thyroid tissue in the mediastinum
- C. Metastatic thyroid carcinoma (Correct Answer)
- D. Lingual thyroid
Explanation: ***Metastatic thyroid carcinoma*** - **Metastatic papillary thyroid carcinoma** to cervical lymph nodes is the most common cause of lateral aberrant thyroid tissue - The term "lateral aberrant thyroid" is a **historical misnomer** that has been abandoned in modern thyroid surgery - What was previously thought to be ectopic thyroid tissue in lateral neck nodes is virtually always **metastatic disease** - Papillary thyroid carcinoma commonly metastasizes to **regional lymph nodes**, which then contain thyroid follicular cells - This represents **lymph node metastases**, not developmental ectopia *Ectopic thyroid tissue due to developmental anomalies* - True developmental ectopia of thyroid tissue in the **lateral neck is extremely rare to nonexistent** - The thyroid gland originates from the **foramen cecum in the midline** and descends along the thyroglossal duct - Developmental ectopic thyroid occurs in **midline structures** (lingual thyroid, thyroglossal duct remnants), not laterally - The concept of "lateral aberrant thyroid" as a developmental anomaly has been **disproven** *Thyroid tissue in the mediastinum* - Mediastinal thyroid tissue represents **substernal or retrosternal goiter** that has descended into the chest - This describes a different anatomical location (mediastinum vs. lateral neck) - Not related to lateral cervical masses *Lingual thyroid* - Lingual thyroid is ectopic thyroid tissue located at the **base of the tongue** - This is a **midline structure**, not a lateral neck finding - Represents failure of thyroid descent during embryological development
Question 963: A child presented with blunt abdominal trauma, the first investigation to be done is -
- A. USG (Correct Answer)
- B. CT Scan
- C. Complete Hemogram
- D. Abdominal X-ray
Explanation: ***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.
Question 964: Vacuum assisted closure is contraindicated in which of the following conditions -
- A. Chronic osteomyelitis
- B. Large amount of necrotic tissue with eschar (Correct Answer)
- C. Abdominal wound
- D. Surgical wound dehiscence
Explanation: ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.
Question 965: Which of the following statements is true regarding cystic hygroma?
- A. Non transilluminant
- B. Develops from jugular lymphatic sequestration (Correct Answer)
- C. Lined by endothelial cells
- D. All of the options
Explanation: ***Develops from jugular lymphatic sequestration*** - **Cystic hygromas** are congenital **lymphatic malformations** that primarily occur in the neck - They arise from the abnormal budding or sequestration of the **jugular lymph sacs** during embryonic development, leading to the formation of dilated lymphatic channels that fail to connect with the venous system - This is the **most specific and characteristic** feature of cystic hygroma pathogenesis *Non transilluminant* - This statement is **incorrect**; cystic hygromas are typically **transilluminant** because they are fluid-filled sacs - The cystic nature of the lesion allows light to pass through, which is a classic diagnostic feature on clinical examination *Lined by endothelial cells* - While this statement is technically true (lymphatic endothelial cells are a type of endothelial cell), it is **not the most specific answer** - This feature is shared with all vascular and lymphatic structures, making it less distinctive for cystic hygromas - The key distinguishing feature is their **embryological origin** from jugular lymphatic sequestration, not just their endothelial lining *All of the options* - This option is **incorrect** because not all statements are true or most appropriate - Only the statement about jugular lymphatic sequestration represents the most specific and correct answer
Question 966: The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:
- A. 5.5 cm (Correct Answer)
- B. 6 cm
- C. 6.5 cm
- D. 7 cm
Explanation: ***5.5 cm*** - An abdominal aortic aneurysm (AAA) 5.5 cm or larger is typically the threshold for considering **elective surgical repair** due to significantly increased **rupture risk**. - For aneurysms smaller than this, the risk of surgery often outweighs the risk of rupture, making watchful waiting with surveillance more appropriate. *6 cm* - While a 6 cm AAA certainly has a very high risk of rupture, the generally accepted guideline for intervention begins at **5.5 cm** for most patients. - Delaying intervention until 6 cm could unnecessarily expose the patient to a higher risk of rupture. *6.5 cm* - An AAA of 6.5 cm carries an extremely high risk of rupture, and intervention would be strongly indicated. - This size is well past the standard **5.5 cm threshold** recommended for elective repair. *7 cm* - A 7 cm AAA is associated with a **critical and very high risk of rupture**, making immediate intervention imperative. - This size is significantly beyond the established guideline for considering elective repair, which is 5.5 cm.
Question 967: Reactionary Hemorrhage occurs due to?
- A. Infection
- B. Damage to a blood vessel
- C. Pressure necrosis
- D. Dislodgement of clot (Correct Answer)
Explanation: ***Dislodgement of clot*** - **Reactionary hemorrhage** occurs within the first 24 hours post-surgery as the initial **vasoconstriction** and **blood pressure drop** from anesthesia resolve. - As blood pressure normalizes and peripheral vessels dilate, a **clot** that formed in a previously bleeding vessel becomes dislodged, leading to bleeding. *Infection* - **Infection** can cause secondary hemorrhage, but this typically occurs later, usually several days to weeks after surgery, due to tissue necrosis and erosion of blood vessels. - It is not the primary mechanism for hemorrhage occurring within the first 24 hours. *Damage to a blood vessel* - **Damage to a blood vessel** during surgery is a cause of primary hemorrhage, which occurs during or immediately after the procedure. - While it initiates the potential for bleeding, reactionary hemorrhage specifically refers to bleeding that resumes due to changes in patient physiology post-operatively, rather than ongoing vessel damage. *Pressure necrosis* - **Pressure necrosis** refers to tissue death due to sustained external pressure, often leading to skin breakdown or deep tissue injury. - It does not directly cause reactionary hemorrhage, although necrotic tissue could potentially contribute to later secondary hemorrhage if a vessel erodes.