NEET-PG 2024 Practice Questions

Q: What is the most frequent complication of Total Parenteral Nutrition (TPN)?

Hyperglycemia. ***Hyperglycemia*** - **Hyperglycemia** is the most common metabolic complication of TPN due to the high dextrose content, especially in patients with pre-existing glucose intolerance or stress. - Close monitoring of blood glucose and insulin administration are often necessary to manage this complication. *Rebound hyperglycemia* - **Rebound hyperglycemia** typically refers to a surge in blood glucose levels following a period of hypoglycemia, or in response to a sudden cessation of insulin, neither of which is the most frequent primary complication of TPN initiation. - While TPN can cause hyperglycemia, the term "rebound hyperglycemia" is not the most accurate description for the initial and most frequent TPN-associated glucose abnormality. *Hypoglycemia* - **Hypoglycemia** is less common during continuous TPN infusion but can occur if TPN is abruptly discontinued, or if excessive insulin is administered. - It is not the most frequent complication observed during steady-state TPN administration. *Hypertriglyceridemia* - **Hypertriglyceridemia** can occur with TPN, particularly with excessive lipid emulsion administration or in patients with impaired lipid metabolism. - Although a potential complication, it is not as frequent as hyperglycemia.

Q: A patient underwent a gastrectomy. Which vitamin replacement is required?

Vitamin B12. ***Vitamin B12*** - **Gastrectomy** removes all or part of the stomach, which is the site of **intrinsic factor** production by parietal cells. - Intrinsic factor is essential for the absorption of **Vitamin B12** (cobalamin) in the terminal ileum; without it, severe B12 deficiency will develop [1]. *Vitamin A* - Vitamin A (retinol) is a **fat-soluble vitamin** primarily absorbed in the small intestine, and its absorption is generally not directly affected by gastrectomy. - Deficiency is usually linked to malabsorption syndromes affecting the small intestine or severe hepatic dysfunction. *Vitamin C* - Vitamin C (ascorbic acid) is a **water-soluble vitamin** absorbed in the small intestine, and its absorption is largely independent of gastric function. - While gastrectomy might impact overall nutrient intake, there's no specific mechanism linking it directly to Vitamin C malabsorption. *Vitamin D* - Vitamin D is a **fat-soluble vitamin** absorbed in the small intestine, and its absorption is primarily dependent on the presence of bile salts and an intact small bowel. - Gastrectomy does not directly impair Vitamin D absorption, although general nutritional deficiencies can occur if dietary intake is insufficient post-surgery.

Q: An endoscopic image shows the following finding. What is the most likely diagnosis?

Barrett's esophagus. ***Barrett's esophagus*** - The endoscopic image shows a **change in the mucosal lining** from the pale, smooth squamous epithelium (typical of the esophagus) to a red, velvety columnar epithelium, which is characteristic of **intestinal metaplasia** occurring in Barrett's esophagus. - This metaplastic change occurs as a complication of chronic gastroesophageal reflux disease (GERD) and is a **precursor to esophageal adenocarcinoma**. *Esophageal varices* - Esophageal varices appear as **dilated, tortuous veins** beneath the esophageal mucosa, often seen in patients with **portal hypertension**. - The image does not show these typical tortuous, bluish veins. *Gastric erosion* - Gastric erosions are **superficial breaks in the gastric mucosa**, typically appearing as reddish spots or streaks, often with overlying exudate. - The image depicts a change in mucosal type rather than superficial damage to the gastric lining. *Chronic GERD* - While chronic GERD is the underlying cause for Barrett's esophagus, the image shows the **consequence of GERD** (metaplasia), not the direct endoscopic signs of active GERD, such as **esophagitis** (inflammation, redness, erosions) in the squamous epithelium. - The distinct change in mucosal appearance to columnar epithelia is specific to Barrett's esophagus. *Esophageal candidiasis* - Esophageal candidiasis presents with **white plaques or pseudomembranes** overlying the esophageal mucosa, typically seen in immunocompromised patients. - The image shows a change in mucosal type (metaplasia) rather than infectious white plaques characteristic of candidiasis.

Q: TTF-1 is a tumor marker for which of the following?

Small cell carcinoma. ***Small cell carcinoma*** - **Thyroid transcription factor 1 (TTF-1)** is a nuclear transcription protein expressed in lung and thyroid neoplasms - It is positive in **85-90% of small cell lung carcinomas**, making it a key immunohistochemical marker [1] - TTF-1 helps differentiate small cell carcinoma from other neuroendocrine tumors and extrapulmonary small cell carcinomas [1] *Adenocarcinoma* - TTF-1 is also **strongly positive in 75-80% of lung adenocarcinomas** - It is a primary marker for lung adenocarcinoma, often used with **Napsin A** and **Cytokeratin 7 (CK7)** *Thymoma* - Thymomas are neoplasms of the **thymus gland** and typically express **cytokeratins** but **not TTF-1** - Characteristic markers include **CD5**, **CD117**, and epithelial markers *Melanoma* - Melanomas are cancers of **melanocytes** and express melanocytic markers like **S-100**, **HMB-45**, **Melan-A**, and **SOX10** - **TTF-1** is not expressed in melanoma and helps exclude lung primary when evaluating metastatic disease **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338.

Q: A 12-year-old child presents to the OPD with a complaint of scrotal pain and a history of trauma 6 hours ago. On surgical exploration, the following finding is observed. What is the most likely diagnosis?

Testicular torsion with gangrene. ***Testicular torsion with gangrene*** - The combination of **scrotal pain**, history of **trauma**, and the image showing a **dark, necrotic testicle** (implying gangrene) is highly indicative of testicular torsion that has progressed to tissue death due to prolonged ischemia. - Testicular torsion is an emergency where the **spermatic cord** twists, cutting off blood supply; after 6 hours, especially following trauma, the risk of non-viability and gangrene is very high. *Torsion of testicular appendages with gangrene* - While torsion of appendages (e.g., appendix testis) can cause acute scrotal pain, it typically results in a **"blue dot sign"** and is usually a **less severe condition** than testicular torsion. - It would not typically lead to the extensive necrotic appearance of the entire testicle as suggested by the scenario, and surgical exploration revealing gangrene usually points to the whole testis being affected. *Gangrene* - While gangrene is present, this option is **incomplete** as it does not specify the underlying cause, which is critical for diagnosis and treatment. - The context of acute scrotal pain and trauma points to a specific etiology, namely torsion. *Hematoma* - A hematoma would present as a **blood collection**, potentially causing swelling and discoloration, but usually **not the black, necrotic changes** indicative of gangrene from ischemia. - While trauma could cause a hematoma, the description of gangrene points to a more severe vascular compromise.

Q: The image shows a Negative Pressure Wound Therapy (NPWT) dressing applied to a patient's wound. What is the ideal negative pressure range commonly used for NPWT to promote wound healing?

-125 mm Hg. ***-125 mm Hg*** - **Negative Pressure Wound Therapy (NPWT)** uses controlled subatmospheric (negative) pressure to promote wound healing. - The most commonly used pressure setting is **-125 mm Hg**, which has been extensively validated in clinical studies. - This pressure level effectively promotes granulation tissue formation, reduces edema, removes exudate, and increases blood flow to the wound bed. - **-75 to -125 mm Hg** is the typical therapeutic range, with -125 mm Hg being the standard setting for most wound types. *60-80 mm Hg* - This represents **positive pressure**, not negative pressure used in NPWT. - NPWT requires subatmospheric (below atmospheric) pressure, denoted by the negative sign. - Positive pressures in this range would be used in compression therapy for venous insufficiency, not vacuum-assisted wound closure. *130 mm Hg* - This is a **positive pressure** value and does not apply to NPWT. - NPWT uses negative (suction) pressure, not positive compression. - If interpreted as -130 mm Hg, this would be at the higher end and might increase patient discomfort without additional benefit over -125 mm Hg. *80-100 mm Hg* - These are **positive pressure** values not used in NPWT. - NPWT specifically requires negative pressure (vacuum/suction) to work effectively. - This range would be excessively high even for compression therapy and inappropriate for NPWT.

Q: Which of these is the STRONGEST indication for giving adjuvant treatment in oral malignancy after resection and Modified Radical Neck Dissection (MRND)?

Extranodal extension. ***Extranodal extension*** - **Extranodal extension (ENE)** is the strongest adverse pathological feature (APF) indicating the highest risk of recurrence and significantly impacting prognosis. - ENE is associated with increased likelihood of regional and distant metastasis. - The presence of ENE mandates **adjuvant concurrent chemoradiotherapy** (not radiotherapy alone), as landmark trials (EORTC 22931, RTOG 9501) demonstrated survival benefit with combined modality treatment. - ENE and positive surgical margins are the two most critical features requiring intensified adjuvant therapy. *Multiple lymph node metastasis* - Multiple positive lymph nodes (≥2 nodes) indicate high risk of recurrence and warrant **adjuvant radiotherapy**. - While this is a significant adverse feature, it does not mandate chemoradiotherapy unless accompanied by ENE or positive margins. - Considered a high-risk feature but not as strong an indication as ENE. *T3 tumor* - T3 tumor indicates significant local invasion but is a clinical staging parameter, not a pathological adverse feature. - The decision for adjuvant therapy depends primarily on pathological findings (margins, lymph node status, ENE) rather than T-stage alone. - T3 status without adverse pathological features may not require adjuvant treatment after complete resection. *Close margin* - Close margin (tumor within 1-5 mm of resected edge) is a high-risk feature warranting **adjuvant radiotherapy** due to increased local recurrence risk. - However, it is less critical than ENE in terms of overall survival and regional control. - A **positive margin** (<1 mm or tumor at ink) would be equivalent to ENE as an indication for chemoradiotherapy, but a close margin typically requires radiotherapy alone.

Q: A patient presents to the OPD with a right-sided ulcerated breast lesion. Radiological imaging shows liver metastasis, as seen in the provided ultrasound image. What is the most appropriate management?

Neoadjuvant chemotherapy followed by surgery. ***Neoadjuvant chemotherapy followed by surgery*** - The presence of **distant metastasis** (liver metastasis) indicates **Stage IV breast cancer**, where **systemic treatment is the primary goal**. - In Stage IV disease, **palliative systemic chemotherapy** is the mainstay of treatment to control distant disease and improve survival. - Surgery in metastatic breast cancer may be considered for **local control of symptomatic disease** (ulceration, bleeding, pain), typically after initiating systemic therapy. - The combination of systemic therapy followed by local surgery for the ulcerated lesion addresses both the metastatic disease and provides local symptom relief. *Simple mastectomy* - While this could provide local control of the ulcerated lesion, it does **not address the distant metastasis**. - In Stage IV disease, **systemic therapy must be prioritized** before considering any local surgical intervention. - Surgery alone without systemic treatment would be inadequate for metastatic disease. *Modified Radical Mastectomy (MRM)* - MRM involves removal of the entire breast tissue, skin, nipple-areolar complex, and level I and II axillary lymph nodes. - While this provides comprehensive local-regional control, it **does not address distant metastasis**. - In Stage IV disease, extensive locoregional surgery without systemic therapy first would be inappropriate, as the primary issue is systemic disease. *Radical mastectomy* - This extensive procedure involves removal of the breast, axillary lymph nodes, and pectoralis muscles. - It is **rarely performed today** due to significant morbidity and no survival benefit over less extensive procedures. - Like other surgical options alone, it fails to address the systemic nature of Stage IV disease.

Q: Identify the instrument shown in the image.

Ureteroscope. ***Ureteroscope*** - The image distinctly shows a long, thin, flexible scope with a working channel, consistent with a **flexible ureteroscope**. - The presence of a **guidewire** alongside the scope further indicates its use for navigating the narrow and tortuous ureter. *Nephroscope* - A nephroscope is typically a more rigid and wider instrument used for percutaneous access to the **kidney's collecting system**. - Its design is optimized for procedures within the kidney, not for navigating the ureter. *Cystoscope* - A cystoscope is used to visualize the **bladder** and urethra and is generally shorter and thicker than a ureteroscope. - While it can be flexible or rigid, the instrument shown is too long and thin to be a standard cystoscope. *Laparoscope* - A laparoscope is a rigid instrument used for **abdominal surgery**, inserted through the abdominal wall. - Its design and application are entirely different from the instrument shown, which is designed for internal urinary tract procedures.

Question 1

What is the most frequent complication of Total Parenteral Nutrition (TPN)?

Accepted Answer

Hyperglycemia

Answer

Rebound hyperglycemia

Answer

Hypoglycemia

Answer

Hypertriglyceridemia

Question 2

A patient underwent a gastrectomy. Which vitamin replacement is required?

Accepted Answer

Vitamin B12

Answer

Vitamin A

Answer

Vitamin C

Answer

Vitamin D

Question 3

A 45-year-old patient presents with hypertension, hematuria, and flank pain. An MRI scan is performed, and the image provided shows multiple cystic lesions in both kidneys. What is the most likely diagnosis?

Accepted Answer

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Answer

Renal cyst

Answer

Renal tumor

Answer

Chronic kidney disease with cystic degeneration

Answer

Acquired cystic kidney disease

Question 4

An endoscopic image shows the following finding. What is the most likely diagnosis?

Accepted Answer

Barrett's esophagus

Answer

Esophageal varices

Answer

Gastric erosion

Answer

Chronic GERD

Answer

Esophageal candidiasis

Question 5

TTF-1 is a tumor marker for which of the following?

Accepted Answer

Small cell carcinoma

Answer

Adenocarcinoma

Answer

Thymoma

Answer

Melanoma

Question 6

A 12-year-old child presents to the OPD with a complaint of scrotal pain and a history of trauma 6 hours ago. On surgical exploration, the following finding is observed. What is the most likely diagnosis?

Accepted Answer

Testicular torsion with gangrene

Answer

Torsion of testicular appendages with gangrene

Answer

Gangrene

Answer

Hematoma

Question 7

The image shows a Negative Pressure Wound Therapy (NPWT) dressing applied to a patient's wound. What is the ideal negative pressure range commonly used for NPWT to promote wound healing?

Accepted Answer

-125 mm Hg

Answer

60-80 mm Hg

Answer

130 mm Hg

Answer

80-100 mm Hg

Question 8

Which of these is the STRONGEST indication for giving adjuvant treatment in oral malignancy after resection and Modified Radical Neck Dissection (MRND)?

Accepted Answer

Extranodal extension

Answer

Multiple lymph node metastasis

Answer

T3 tumor

Answer

Close margin

Question 9

A patient presents to the OPD with a right-sided ulcerated breast lesion. Radiological imaging shows liver metastasis, as seen in the provided ultrasound image. What is the most appropriate management?

Accepted Answer

Neoadjuvant chemotherapy followed by surgery

Answer

Simple mastectomy

Answer

Modified Radical Mastectomy (MRM)

Answer

Radical mastectomy

Question 10

Identify the instrument shown in the image.

Accepted Answer

Ureteroscope

Answer

Nephroscope

Answer

Cystoscope

Answer

Laparoscope

NEET-PG 2024

General Medicine

Internal Medicine

Pathology

Surgery