NEET-PG 2018 Practice Questions

Q: Which of the following layers contains Odland bodies?

B. ***B*** - The layer indicated by **B** is the **stratum granulosum**, which is characterized by the presence of **keratohyalin granules** and **Odland bodies** (lamellar bodies). - **Odland bodies** are crucial for forming the **epidermal water barrier** as they release lipids and enzymes into the intercellular space. *A* - The layer indicated by **A** is the **stratum corneum**, which consists of dead, flattened keratinocytes. - This layer is primarily involved in protection and does not contain Odland bodies, which are found in deeper layers. *C* - The layer indicated by **C** is the **stratum spinosum**, characterized by many **desmosomes** giving a "spiny" appearance. - While cells in this layer are metabolically active and produce keratin, Odland bodies primarily form and are extruded in the stratum granulosum. *D* - The layer indicated by **D** is the **stratum basale** (or stratum germinativum), the deepest layer of the epidermis. - This layer contains **stem cells** that are constantly dividing to replenish the epidermal layers and is also where melanocytes are located; it does not contain Odland bodies.

Q: This condition shown below is dependent on development of pH of urine. Which of the following subtype development is insensitive to pH of urine?

Calcium oxalate. ***Calcium oxalate*** - **Calcium oxalate stones** are the most common type and form **independently of urine pH**, although they can form in a wide range of pH conditions. - Precipitation of calcium oxalate is primarily influenced by concentrations of **calcium and oxalate** in urine, not pH. *Triple phosphate* - **Triple phosphate (struvite) stones** are highly sensitive to **alkaline urine** (pH > 7.0), as they typically form in the presence of urea-splitting bacteria. - These stones are often large, grow rapidly, and are associated with **urinary tract infections**. *Uric acid* - **Uric acid stones** are highly dependent on urine pH, typically forming in **acidic urine** (pH < 5.5). - Alkalinizing the urine (e.g., with potassium citrate) can help **dissolve existing uric acid stones** and prevent new formation. *Cystine* - **Cystine stones** are also pH-sensitive, forming primarily in **acidic urine**, due to the reduced solubility of cystine at lower pH levels. - Urine alkalinization is a key therapeutic strategy for managing cystine stone formation.

Q: All are correct about the condition shown in the image except: (NEET Pattern 2018)

Most common site is middle esophagus. ***Most common site is middle esophagus*** - The question asks for the incorrect statement, and this statement is actually **correct** for esophageal squamous cell carcinoma (SCC), which is the most common type of esophageal cancer globally. - **Squamous cell carcinoma** of the esophagus most frequently occurs in the **middle third** of the esophagus [1]. *Most common gross presentation is fungating subtype* - This statement is incorrect. The most common gross presentation of esophageal carcinoma is the **ulcerative type**, followed by fungating and infiltrative types [1]. - **Fungating tumors** are exophytic and protrude into the lumen, but they are not the most common gross morphology. *Stage 3 cancer oesophagus has 25 % survival rate* - This statement is incorrect. The 5-year survival rate for **Stage III esophageal cancer** is significantly lower, typically ranging from **10-15%**, not 25% [2][3]. - Survival rates for esophageal cancer are generally poor, especially in advanced stages due to early metastasis and late presentation. *Vomiting of previous day food items* - This statement is incorrect. Vomiting of previous day's food items is characteristic of **pyloric stenosis** or **gastric outlet obstruction**, not typically esophageal cancer. - Esophageal cancer usually presents with **dysphagia** (difficulty swallowing) and **regurgitation** of recently ingested food, not undigested food from the previous day [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 766-767. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 349-350. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 765-766.

Q: A 60-year-old man with tobacco chewing history presents with trismus and ankyloglossia. The lesion is shown below. Diagnosis is? (NEET Pattern 2018)

Submucosal fibrosis. ***Submucosal fibrosis*** - **Oral submucous fibrosis (OSMF)** is a chronic, progressive, precancerous condition of the oral cavity characterized by juxta-epithelial fibrosis. It is strongly associated with **areca nut (betel nut) chewing**, often found in tobacco products [1]. - Clinical features include **trismus** (difficulty opening the mouth due to fibrosis of the oral tissues), burning sensation, and **ankyloglossia** (restricted tongue movement) due to fibrosis of the lingual frenum. *Erythroplakia* - **Erythroplakia** is a red patch or lesion in the oral cavity that cannot be characterized clinically or pathologically as any other definable disease. - It is considered a highly dysplastic or **premalignant lesion**, but its primary presentation is a red, velvety patch, not primarily trismus or ankyloglossia. *Chronic hyperplastic candidiasis* - **Chronic hyperplastic candidiasis** (Candidal leukoplakia) is a persistent white lesion that cannot be removed by scraping, caused by chronic *Candida albicans* infection [2]. - While it is a precancerous condition, its main clinical feature is a **white patch** or plaque, and it does not typically cause severe trismus or ankyloglossia as primary symptoms. *Jaffe's tumor* - **Jaffe's tumor** is an outdated term for **fibrous dysplasia**, a bone disorder where normal bone is replaced by fibrous tissue and immature woven bone. - It primarily affects bones, and while it can occur in the jaw, it does not present with the classic oral mucosal symptoms of trismus and ankyloglossia associated with tobacco chewing. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 344-345. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 736-737.

Q: The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Nyhus Type IIIB. ***Nyhus Type IIIB*** - The image shows a hernia occurring within **Hesselbach's triangle**, which is the anatomical site for a **direct inguinal hernia**. A direct inguinal hernia is classified as **Nyhus Type III**, as it involves a defect in the posterior wall of the inguinal canal, medial to the inferior epigastric vessels. - The "B" in Nyhus Type IIIB specifically denotes a **direct inguinal (III) hernia with a weakness in the posterior inguinal wall**. While the question asks for the specific Nyhus classification, options like Nyhus Type I, Type II, and Type IIIA, as well as a femoral hernia (Nyhus Type IV), are inconsistent with the highlighted location. *Nyhus Type I* - This classification refers to an **indirect inguinal hernia** where the internal ring is normal, typically seen in children. - It would originate lateral to the inferior epigastric artery, unlike the highlighted region. *Nyhus Type II* - This type describes an **indirect inguinal hernia** with an enlarged internal ring but an intact posterior inguinal wall. - This type of hernia would still originate lateral to the inferior epigastric vessels, not within Hesselbach's triangle. *Nyhus Type IIIA* - Nyhus Type IIIA specifically classifies an **indirect inguinal hernia** with an enlarged internal ring and a completely destructed transversalis fascia. - While it's also a Type III (indirect), Type IIIA refers to an indirect hernia, which emerges lateral to the inferior epigastric vessels, whereas a direct hernia (within Hesselbach's triangle) emerges medial to these vessels. *Nyhus Type IV* - This classification is for a **femoral hernia**, which occurs inferior to the inguinal ligament and through the femoral canal. - The highlighted area is clearly superior to the inguinal ligament and within the inguinal region, not the femoral region.

Q: A person could not pass urine after a fall shown below. On examination vitals are stable but bladder is palpable. What is the probable diagnosis? (NEET Pattern 2018)

Anterior urethra rupture. ***Anterior urethra rupture*** - The mechanism of injury - a **fall causing straddle trauma** (man falling into manhole) - is the classic cause of **bulbar urethral injury**, affecting the anterior urethra where it passes through the urogenital diaphragm. - Inability to pass urine with **palpable bladder** indicates urinary retention from complete urethral disruption, with the classic triad of **inability to void, blood at urethral meatus, and distended bladder**. *Posterior urethra rupture* - Requires **high-energy trauma** causing **pelvic fractures** (like road traffic accidents), not the straddle injury mechanism shown in the fall. - Associated with **membranous urethral injury** above the urogenital diaphragm, typically seen with **symphysis pubis or sacroiliac joint disruption**. *Penile avulsion* - Involves **complete or partial tearing** of penile skin or deeper structures, presenting with **obvious external hemorrhage and tissue loss**. - Would not primarily present as urinary retention without visible **external genital trauma or bleeding**. *Recto-urethral injury* - Results from **penetrating trauma** or severe **crush injuries** affecting both rectum and urethra simultaneously. - Would present with additional signs like **rectal bleeding, fecaluria, or pneumaturia**, which are not described in this case.

Q: Which is the most common site of peripheral aneurysm?

B. ***Option B*** - This image points to the **popliteal artery**, which is the most common site for **peripheral aneurysms**. - **Popliteal artery aneurysms** account for approximately 70% of all peripheral aneurysms and are more common in men. *Option A* - This image points to the **brachial artery** in the upper arm, which is a less common site for aneurysms. - While aneurysms can occur here, they are not as frequent as in the popliteal artery. *Option C* - This image points to the **femoral artery** in the groin region. - Although the femoral artery can be affected by aneurysms, they are less common than popliteal artery aneurysms. *Option D* - This image points to the **tibial arteries** in the lower leg. - Aneurysms in the tibial arteries are rare and typically much less common than those in the popliteal artery. *Option E* - This image points to the **radial artery** in the forearm. - Radial artery aneurysms are very rare and usually occur secondary to trauma or iatrogenic injury, not spontaneously like popliteal aneurysms.

Q: In the MRI breast shown below, 4 cm mass is present with no nodal metastasis. Which is the stage of breast cancer?

Stage II. ***Stage II*** - A tumor of **4 cm** with no nodal metastasis is classified as pT2, N0, M0. This falls under **Stage IIA** breast cancer according to the TNM staging system. - Stage II breast cancer typically includes tumors that are larger than 2 cm but not larger than 5 cm (T2N0), or smaller tumors with lymph node involvement. - The **4 cm size with N0 status** specifically defines Stage IIA. *Stage 0* - Stage 0 represents **ductal carcinoma in situ (DCIS)** or **lobular carcinoma in situ (LCIS)**, which are non-invasive breast cancers. - This case describes a **4 cm mass**, indicating an invasive tumor, not in-situ disease, ruling out Stage 0. *Stage I* - Stage I breast cancer includes tumors that are **2 cm or smaller** (T1) and have no lymph node involvement (N0). - Since the mass is **4 cm**, it exceeds the size criteria for Stage I. *Stage III* - Stage III breast cancer involves **larger tumors** (greater than 5 cm) or any tumor size with extensive lymph node involvement, or tumors invading the chest wall/skin. - While this mass is 4 cm, there is **no nodal metastasis**, which rules out Stage III. *Stage IV* - Stage IV breast cancer indicates the presence of **distant metastases** (M1), meaning the cancer has spread to other parts of the body. - The information provided clearly states **no nodal metastasis**, and no information about distant spread, therefore Stage IV is incorrect.

Q: A 35-year-old patient with history of significant weight loss and medically refractory constipation underwent a barium enema shown below. In how many % of cases Metastatic liver disease is found?

33 %. ***33 %*** - Approximately **20-25% of colorectal cancer patients present with synchronous liver metastases** at initial diagnosis, and another **15-25% develop metachronous metastases** during follow-up. - The figure of **33% represents a reasonable approximation** of the overall incidence, considering both presentation and subsequent development of liver metastases. - The liver is the **most common site of distant metastasis** in colorectal cancer due to portal venous drainage from the colon directly to the liver. - This makes **33% the most accurate answer** among the given options for the cumulative incidence of metastatic liver disease. *75 %* - This is a **significant overestimation** of the true incidence of liver metastases in colorectal cancer patients. - While the liver is the most common metastatic site, **only 20-25% have liver metastases at presentation**, and the cumulative lifetime incidence reaches approximately 40-50%, not 75%. - This exaggerated figure does not align with current epidemiological data. *10 %* - This is **too low** and underestimates the true burden of liver metastatic disease in colorectal cancer. - Given that approximately one-quarter of patients present with liver metastases at diagnosis alone, 10% significantly underrepresents the actual incidence. *15 %* - This also **underestimates** the true incidence of liver metastases in colorectal cancer patients. - While 15% might represent a specific subset or early-stage disease, it does not reflect the overall cumulative incidence of metastatic liver disease.

Q: A 9-month-old child presents with excessive cry and presentation shown below. On examination right iliac fossa sausage shaped lump is felt. What is the best treatment?

IVF- Antibiotic-Air enema. ***IVF- Antibiotic-Air enema*** - The clinical picture (9-month-old with excessive cry, **"currant jelly" stool** (image), and a **right iliac fossa sausage-shaped lump**) is classic for **intussusception**. - Initial management involves **resuscitation** (IV fluids), **antibiotics** to prevent sepsis from bowel ischemia, and then an **air enema** for both diagnosis and non-surgical reduction. - Air enema has a **success rate of 70-90%** for uncomplicated cases and is the **first-line treatment**. *IVF- Antibiotic- NG tube* - While IVF and antibiotics are appropriate initial steps for an ill child with presumed intussusception, an **NG tube** alone is insufficient for treating the intussusception itself. - An NG tube is primarily used for **gastric decompression** in cases of bowel obstruction, which may be a complication of intussusception, but it does not resolve the invagination. *IVF-Antibiotics- Barium enema* - A **barium enema** can also be used for reduction, but an **air enema** is generally preferred due to a **lower risk of peritoneal contamination** if perforation occurs and better visualization under fluoroscopy. - While it has diagnostic and therapeutic potential, air enema is often considered safer and equally effective. *IVF- Antibiotics-Warm saline enema* - This option lacks the specific pressure-based mechanism required to reduce an intussusception effectively. - A **warm saline enema** is a general type of enema, but it does not provide the controlled pressure needed for hydrostatic or pneumatic reduction of intussusception. *IVF- Antibiotics- Laparotomy* - **Laparotomy** (surgical reduction) is reserved for cases where **pneumatic reduction fails**, **signs of peritonitis** are present, or there is **suspected bowel perforation**. - Initial management should always attempt non-surgical reduction first unless contraindications exist (free air, hemodynamic instability, peritonitis).

Question 1

Which of the following layers contains Odland bodies?

Accepted Answer

B

Answer

A

Answer

C

Answer

D

Question 2

This condition shown below is dependent on development of pH of urine. Which of the following subtype development is insensitive to pH of urine?

Accepted Answer

Calcium oxalate

Answer

Triple phosphate

Answer

Uric acid

Answer

Cystine

Question 3

All are correct about the condition shown in the image except: (NEET Pattern 2018)

Accepted Answer

Most common site is middle esophagus

Answer

Most common gross presentation is fungating subtype

Answer

Stage 3 cancer oesophagus has 25 % survival rate

Answer

Vomiting of previous day food items

Answer

Loss of ganglion cells in myenteric plexus

Question 4

A 60-year-old man with tobacco chewing history presents with trismus and ankyloglossia. The lesion is shown below. Diagnosis is? (NEET Pattern 2018)

Accepted Answer

Submucosal fibrosis

Answer

Erythroplakia

Answer

Chronic hyperplastic candidiasis

Answer

Jaffe's tumor

Question 5

The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Accepted Answer

Nyhus Type IIIB

Answer

Nyhus Type I

Answer

Nyhus Type II

Answer

Nyhus Type IIIA

Question 6

A person could not pass urine after a fall shown below. On examination vitals are stable but bladder is palpable. What is the probable diagnosis? (NEET Pattern 2018)

Accepted Answer

Anterior urethra rupture

Answer

Posterior urethra rupture

Answer

Penile avulsion

Answer

Recto-urethral injury

Question 7

Which is the most common site of peripheral aneurysm?

Accepted Answer

B

Answer

A

Answer

C

Answer

D

Answer

E

Question 8

In the MRI breast shown below, 4 cm mass is present with no nodal metastasis. Which is the stage of breast cancer?

Accepted Answer

Stage II

Answer

Stage I

Answer

Stage III

Answer

Stage IV

Answer

Stage 0

Question 9

A 35-year-old patient with history of significant weight loss and medically refractory constipation underwent a barium enema shown below. In how many % of cases Metastatic liver disease is found?

Accepted Answer

33 %

Answer

10 %

Answer

15 %

Answer

75 %

Question 10

A 9-month-old child presents with excessive cry and presentation shown below. On examination right iliac fossa sausage shaped lump is felt. What is the best treatment?

Accepted Answer

IVF- Antibiotic-Air enema

Answer

IVF- Antibiotic- NG tube

Answer

IVF-Antibiotics- Barium enema

Answer

IVF- Antibiotics-Warm saline enema

Answer

IVF- Antibiotics- Laparotomy

NEET-PG 2018

Dermatology

General Medicine

Pathology

Surgery