NEET-PG 2018 Practice Questions

Q: The following appearance of esophagus is seen in:

Eosinophilic esophagitis. ***Eosinophilic esophagitis*** - The image clearly shows **trachealization** of the esophagus, characterized by **concentric rings** and **linear furrows**, which are hallmark endoscopic findings of eosinophilic esophagitis. - This condition is an **allergic inflammatory disorder** involving the esophagus, often leading to dysphagia and food impaction. *GERD* - While GERD can cause inflammation (esophagitis), it typically presents with **erosions**, **strictures**, or **Barrett's esophagus**, but not the characteristic ringed appearance seen here. - The presence of **longitudinal furrows** and a pale, corrugated appearance rather than the distinct circular rings would be less typical for classic GERD. *Stricture* - A stricture would appear as a **localized narrowing** of the esophageal lumen, which is not the predominant feature in this image. - While strictures can occur in chronic eosinophilic esophagitis, the primary morphological feature visualized is the **ringed esophagus**. *Radiation esophagitis* - This condition results from **radiation exposure** to the chest and typically presents with **mucosal edema**, **erythema**, **ulcerations**, or **fibrosis** in acute and chronic phases, respectively. - It does not commonly cause the distinctive **trachealization** or ringed appearance seen in the image.

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).

Q: Which is the best method to secure airway and administer oxygen in case of burns shown below?

Elective intubation. ***Elective intubation*** - The image shows **severe facial burns** consistent with potential **inhalation injury**, which can lead to rapid **airway edema and obstruction**. Elective intubation is critical to secure the airway *before* it becomes impossible to intubate due to swelling. - Signs of inhalation injury, such as **sooty sputum**, **facial burns**, and **singed nasal hairs**, warrant aggressive airway management. *Mask* - Using a mask for oxygen delivery provides only a **low flow of oxygen** and does not secure the airway, which is crucial in cases of severe facial burns and suspected inhalation injury. - A mask will not prevent **airway swelling and obstruction**, which can rapidly worsen in burn patients. *Nasal prongs* - Nasal prongs are a **low-flow oxygen delivery system** and are entirely inadequate for patients with severe burns, especially when airway compromise is a significant risk. - They also would not address the impending **airway edema** associated with facial and inhalation burns. *Tracheostomy* - A tracheostomy is a **surgical airway** procedure that is more invasive and typically reserved for situations where endotracheal intubation is either impossible or long-term airway support is required. - While it provides a secure airway, **elective intubation** is the preferred initial approach because it is less invasive and can be performed more rapidly in an emergency setting.

Q: A 60-year-old male smoker presents with discoloration of urine and has brought a sample to your clinic. He denies any pain or discomfort while passing urine. No history of fever is present. IVU of the patient is shown. Which is the next best investigation to be done?

Cystoscopy. ***Cystoscopy*** - The patient presents with **painless hematuria** and a history of smoking, which are classic indicators of **bladder cancer**. The IVU may also suggest filling defects or abnormalities in the bladder. - Cystoscopy offers **direct visualization of the bladder and urethra**, allowing for biopsy of any suspicious lesions, which is crucial for diagnosis and staging of bladder cancer. *Urine cytology* - While urine cytology can detect malignant cells, its **sensitivity for low-grade tumors is limited**, and it cannot pinpoint the exact location or extent of the lesion. - A definitive diagnosis of bladder cancer requires **histopathological confirmation**, which cytology alone cannot provide. *USG abdomen* - USG can detect some renal and bladder abnormalities, but it is **not as sensitive or specific as cystoscopy** for detecting small or flat bladder lesions. - It's a good initial screening tool but **lacks the diagnostic precision** needed to investigate painless hematuria suspected to be from the bladder. *DMSA scan* - A DMSA scan is primarily used to assess **renal cortical function** and identify cortical scarring or anomalies, not for investigating hematuria or bladder pathologies. - It provides no information about the **urethra or bladder lumen**, which are critical for evaluating the cause of painless hematuria in this patient.

Q: A 70-year-old man underwent the procedure shown below. 3rd day he develops seizures. What is the diagnosis?

Water intoxication. ***Water intoxication*** - The image depicts a **transurethral resection of the prostate (TURP)** using a resectoscope. During TURP, large volumes of **hypotonic irrigation fluid** are used. - If excess fluid is absorbed into the systemic circulation, it can lead to **dilutional hyponatremia** and subsequent **cerebral edema**, causing neurological symptoms like **seizures** post-operatively. *Anesthetic over-dosage* - Anesthetic overdose would typically manifest during or immediately after the procedure with respiratory and cardiovascular depression, not delayed seizures on the third day. - The patient's presentation of seizures several days post-operatively does not align with acute anesthetic toxicity. *Mismatched blood transfusion* - A mismatched blood transfusion would present with acute symptoms like fever, chills, hemoglobinuria, and hypotension, usually *during* or immediately after the transfusion, not delayed neurological symptoms. - Blood transfusions are not routinely part of a TURP procedure unless significant bleeding occurs. *Malignant hyperthermia* - Malignant hyperthermia is a rare, life-threatening **hypermetabolic state** triggered by certain general anesthetics, characterized by rapid onset of high fever, muscle rigidity, and tachycardia. - It occurs *during* or very soon after anesthesia and would not typically present as seizures on the third post-operative day.

Q: Which of the following is not an indication for surgery in the condition shown below?

Patient's decision. ***Patient's decision*** - While patient preferences are crucial in medical decision-making, simply the **patient's decision alone is not a primary medical indication for surgery** in the absence of other objective criteria for a fibroadenoma. - Surgery for **fibroadenoma** is typically guided by clinical and radiological findings, not solely by patient request. *Size more than 5 cm* - A **fibroadenoma** with a size of **more than 5 cm** is generally considered a strong indication for surgical excision. - Large fibroadenomas can cause **cosmetic distortion**, discomfort, and may be harder to distinguish from malignant lesions, especially if they show rapid growth. *Complex type* - **Complex fibroadenomas** have features such as **cysts larger than 3 mm**, sclerosing adenosis, epithelial calcifications, or papillary apocrine metaplasia. - These features are associated with a slightly **increased risk of future breast cancer** and are often considered an indication for excision to rule out malignancy and for risk reduction. *Recurrence* - If a **fibroadenoma recurs** after previous excision, particularly if it grows rapidly or shows atypical features, surgical removal is indicated. - **Recurrence** suggests a persistent or potentially more aggressive benign process that warrants further investigation and management. *Rapid increase in size* - A **rapid increase in size** of a fibroadenoma is a clear indication for surgical excision. - Rapid growth raises concern for **phyllodes tumor** or other potentially aggressive lesions and warrants histopathological examination. - Serial measurements showing significant growth over a short period (typically doubling in size over 3-6 months) indicate the need for surgical intervention.

Q: Which of the following uroflowmetry recording indicates BPH?

Curve 3. ***Curve 3*** - Curve 3 shows a **low, flattened peak flow rate** (around 5 mL/sec) and a **prolonged voiding time**, which is characteristic of significant bladder outlet obstruction due to BPH. - The **sustained low flow** indicates constant effort to overcome resistance, a common finding in BPH. *Curve 1* - Curve 1 depicts a **high peak flow rate** (around 30 mL/sec) and a **short voiding time**, representing a normal and efficient urinary flow pattern. - This pattern is inconsistent with BPH, which is characterized by obstructed flow. *Curve 2* - Curve 2 indicates a **moderately reduced peak flow rate** (around 15 mL/sec) and a somewhat prolonged voiding time compared to normal. - While reflecting some degree of obstruction or weaker detrusor function, it is less severe than curve 3 and may represent early BPH or other conditions. *Curve 4* - Curve 4 shows an **intermittent or staccato flow pattern**, which typically indicates detrusor-sphincter dyssynergia or abdominal straining during voiding. - This pattern is not characteristic of BPH, which typically shows a continuous low flow rather than intermittent flow.

Q: The following test was performed on the patient. Which is correct about the patient?

Pain decreases on standing still. ***Pain decreases on standing still*** - The image depicts the measurement of **Ankle-Brachial Index (ABI)**, a diagnostic test for **Peripheral Artery Disease (PAD)**. - **Intermittent claudication** is the hallmark symptom of PAD, characterized by cramping pain in the legs that develops **after walking a certain distance** and is **relieved by rest** (standing still). - This occurs because the narrowed arteries cannot supply adequate blood flow during exercise, causing muscle ischemia and pain that resolves when activity ceases. *Pain is present on first step of walking* - This is **incorrect** for claudication, which requires time to develop as muscles become ischemic during sustained activity. - Pain on the **first step** would suggest **musculoskeletal pathology** (arthritis, plantar fasciitis) or **neurological issues** (nerve compression), not vascular claudication. - Claudication distance is a key diagnostic feature - patients can walk a reproducible distance before pain begins. *Pain is present at rest* - **Rest pain** indicates **critical limb ischemia**, a severe form of PAD where blood flow is inadequate even at rest. - This represents advanced arterial disease beyond simple claudication and requires urgent evaluation for revascularization. - Rest pain typically affects the forefoot and is worse at night when lying flat. *Pain increases on limb dependency* - Actually, **limb dependency (hanging the leg down)** typically **relieves pain** in severe PAD by using gravity to improve distal perfusion. - Patients with critical limb ischemia often sleep with legs dependent or dangle feet off the bed for relief. - This is opposite to **venous insufficiency**, where elevation improves symptoms.

Q: Which subtype of gastric ulcer is shown in the image?

Lesser curvature at incisura. ***Lesser curvature at incisura*** - The image clearly labels the **incisura angularis (Incision)**, which is a notch on the lesser curvature of the stomach. Gastric ulcers frequently occur at this location. - Ulcers at the incisura are often associated with **Type I gastric ulcers**, which are typically found on the lesser curvature. *High on lesser curvature* - While ulcers can occur high on the lesser curvature (Type II or III, depending on whether there's an associated duodenal ulcer), the label in the image specifically points to the **incisura**. - High lesser curvature ulcers are distinct from those precisely at the incisura, which is a more distal point on the lesser curvature. *Greater curvature* - Ulcers on the **greater curvature** are relatively rare and often raise suspicion for malignancy. - The image explicitly shows a potential ulcer location along the lesser curvature, not the greater curvature. *Pre-pyloric* - **Pre-pyloric ulcers** are located in the region immediately before the pylorus, in the antrum. - The label in the image is proximal to the pylorus, but specifically points to the incisura, which is generally considered part of the gastric body/antrum junction rather than solely pre-pyloric. *Cardia* - **Type IV gastric ulcers** occur at the cardia, near the gastroesophageal junction. - The image shows the incisura angularis on the lesser curvature, which is significantly distal to the cardia.

Q: Which is correct about tumor found in the triangle location shown below?

Associated with MEN1. ***Associated with MEN1*** - The triangle shown in the image represents the **Gastrinoma Triangle**, a common location for gastrin-producing tumors (gastrinomas) to occur. - Approximately 20-30% of gastrinomas are associated with **Multiple Endocrine Neoplasia type 1 (MEN1)** syndrome, which involves tumors of the parathyroid glands, pituitary gland, and pancreas. *Most common site is stomach* - The most common primary site for gastrinomas is the **duodenum** (50-70%), followed by the pancreas (20-40%). - Gastrinomas found in the stomach are rare and usually associated with MEN1, but the duodenum is the predominant site overall. *Best test for diagnosis is pentagastrin test* - The **pentagastrin stimulation test** is used to assess maximal acid output but it is not specific for diagnosing gastrinomas. - The **secretin stimulation test** is the most sensitive and specific provocative test for gastrinoma, as secretin normally inhibits gastrin release from G cells but paradoxically stimulates it in gastrinomas. *Metastasis to adjacent gut* - Gastrinomas are malignant neuroendocrine tumors that commonly **metastasize to regional lymph nodes** and the **liver**. - While they can invade locally, metastasis typically involves distant sites rather than just the adjacent gut wall. *Primary treatment is medical with proton pump inhibitors* - While **proton pump inhibitors (PPIs)** are essential for managing acid hypersecretion symptoms, they are not the primary definitive treatment. - **Surgical resection** is the primary treatment for localized, sporadic gastrinomas when feasible, offering potential cure. - PPIs serve as adjunctive medical therapy to control symptoms but do not address the underlying tumor.

Question 1

The following appearance of esophagus is seen in:

Accepted Answer

Eosinophilic esophagitis

Answer

GERD

Answer

Stricture

Answer

Radiation esophagitis

Question 2

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

Question 3

Which is the best method to secure airway and administer oxygen in case of burns shown below?

Accepted Answer

Elective intubation

Answer

Mask

Answer

Nasal prongs

Answer

Tracheostomy

Question 4

A 60-year-old male smoker presents with discoloration of urine and has brought a sample to your clinic. He denies any pain or discomfort while passing urine. No history of fever is present. IVU of the patient is shown. Which is the next best investigation to be done?

Accepted Answer

Cystoscopy

Answer

Urine cytology

Answer

USG abdomen

Answer

DMSA scan

Question 5

A 70-year-old man underwent the procedure shown below. 3rd day he develops seizures. What is the diagnosis?

Accepted Answer

Water intoxication

Answer

Anesthetic over-dosage

Answer

Mismatched blood transfusion

Answer

Malignant hyperthermia

Question 6

Which of the following is not an indication for surgery in the condition shown below?

Accepted Answer

Patient's decision

Answer

Size more than 5 cm

Answer

Complex type

Answer

Recurrence

Answer

Rapid increase in size

Question 7

Which of the following uroflowmetry recording indicates BPH?

Accepted Answer

Curve 3

Answer

Curve 1

Answer

Curve 2

Answer

Curve 4

Question 8

The following test was performed on the patient. Which is correct about the patient?

Accepted Answer

Pain decreases on standing still

Answer

Pain is present at rest

Answer

Pain is present on first step of walking

Answer

Pain increases on limb dependency

Question 9

Which subtype of gastric ulcer is shown in the image?

Accepted Answer

Lesser curvature at incisura

Answer

High on lesser curvature

Answer

Greater curvature

Answer

Pre-pyloric

Answer

Cardia

Question 10

Which is correct about tumor found in the triangle location shown below?

Accepted Answer

Associated with MEN1

Answer

Most common site is stomach

Answer

Best test for diagnosis is pentagastrin test

Answer

Metastasis to adjacent gut

Answer

Primary treatment is medical with proton pump inhibitors

NEET-PG 2018

Internal Medicine

Surgery