NEET-PG 2012 Practice Questions

Q: Epulis arises from -

Gingiva. ***Gingiva*** - **Epulis** refers to a localized, tumor-like enlargement of the **gingiva** (gum tissue). - These lesions are typically inflammatory or reactive in nature, arising from the connective tissue of the gum. *Enamel* - **Enamel** is the hard, outermost protective layer of the tooth crown, which is of ectodermal origin. - Lesions originating from enamel itself are rare and typically involve developmental defects or structural damage, not soft tissue growths like epulis. *Root of teeth* - The **root of the teeth** is embedded in the alveolar bone and covered by cementum, with the surrounding structures including the periodontal ligament and alveolar bone. - While infections or cysts can arise from the root, epulis specifically describes a growth of the overlying **gingival tissue**. *Pulp* - The **pulp** is the soft tissue inside the tooth containing nerves, blood vessels, and connective tissue. - Pathologies originating from the pulp are typically infectious (pulpitis), degenerative, or involve growth of odontogenic tissues (e.g., pulp polyps within the tooth chamber), not surface gingival lesions.

Q: Migraine is due to

Cortical spreading depression. ***Cortical spreading depression*** - The current understanding is that **cortical spreading depression (CSD)** is the initiating event in migraine with aura, characterized by a wave of neuronal and glial depolarization that spreads across the cerebral cortex, leading to a temporary shutdown of neuronal activity [1]. - CSD is thought to activate the **trigeminal nerve**, subsequently causing the release of inflammatory neuropeptides and contributing to the pain phase [1]. *Dilatation of cranial blood vessels* - While **vasodilation of intracranial and extracranial blood vessels** does occur during the headache phase of migraine, it is now considered a *consequence* of the initial neurological events rather than the primary cause [1]. - This vasodilation contributes to the throbbing sensation of migraine pain but does not explain the aura or the initiation of the attack. *Constriction of cranial blood vessels* - **Vasoconstriction** was previously thought to be the cause of the migraine aura, but this theory has largely been disproven. - While some temporary constriction may precede CSD, it is not the primary mechanism behind the migraine attack. *Inflammation of the meninges* - While **neurogenic inflammation** of the meninges, involving the release of inflammatory mediators like **calcitonin gene-related peptide (CGRP)**, does play a role in sensitizing the trigeminal system and contributing to migraine pain, it is a downstream effect. - It is not the initial trigger for a migraine attack but rather part of the pain pathway activated by events like CSD.

Q: What is the first symptom of leprosy?

Decreased pain. Decreased pain - Leprosy primarily targets Schwann cells in peripheral nerves, leading to sensory loss [1]. - The sensation of pain is typically affected earliest, often presenting as areas of numbness [1]. Decreased vibration & position sense - These sensations are typically carried by larger myelinated fibers, which tend to be affected later in the disease progression of leprosy. - While eventually involved, they are not usually the first symptom of sensory loss. Decreased temperature - Temperature sensation is also an early modality affected in leprosy, as it's carried by small, unmyelinated or thinly myelinated fibers [1]. - However, pain is often cited as the very first sensory loss, even preceding temperature changes in some cases. Decreased light touch - Light touch sensation is generally an early loss, similar to pain and temperature, due to damage to nerve fibers in the skin. - But, when distinguishing the absolute first symptom, pain perception often shows impairment even before light touch in affected areas.

Q: Which of the following is not considered a contraindication for pancreaticoduodenectomy?

Portal vein involvement. ***Portal vein involvement*** - While extensive portal vein invasion can make the procedure challenging, **segmental portal vein involvement without complete occlusion or direct invasion of the superior mesenteric artery** is often considered resectable with venous reconstruction and is not an absolute contraindication. - Advancements in surgical techniques and patient selection criteria allow for **safe resection and reconstruction of the portal vein** in carefully chosen cases, improving outcomes for patients who would otherwise be deemed inoperable. *Metastasis* - The presence of **distant metastases** (e.g., to the liver, peritoneum, or lungs) unequivocally indicates **Stage IV disease** and is an absolute contraindication to pancreaticoduodenectomy, as the surgery would not offer a curative benefit. - In such cases, systemic chemotherapy or palliative care is the more appropriate treatment approach, as resection would not alter the overall prognosis. *Stage III CA head of pancreas* - **Stage III carcinoma of the head of the pancreas** often implies **locally advanced disease** that involves major peripancreatic vessels, such as the superior mesenteric artery or celiac axis. - This level of extensive vascular involvement typically renders the tumor **unresectable**, making pancreaticoduodenectomy surgically unfeasible and a contraindication. *Extensive invasion of superior mesenteric vein* - **Extensive involvement of the superior mesenteric vein (SMV)**, particularly if it completely occludes the lumen or involves a long segment making reconstruction impossible, is generally considered a contraindication to pancreaticoduodenectomy. - While limited SMV involvement with reconstructive options might be resectable, **extensive, unreconstructable invasion** signifies locally advanced disease beyond surgical cure.

Q: Diversion of urine is best done at

Ileum. ***Ileum*** - The **ileum** is the most commonly used segment for urinary diversion due to its **mobility**, adequate vascular supply, and low complication rates. - Its relatively **low absorptive capacity** for electrolytes, particularly urea and ammonia, minimizes metabolic disturbances. *Jejunum* - The **jejunum** has a high absorptive capacity, which can lead to significant **electrolyte imbalances** (e.g., hypochloremic, hypokalemic metabolic acidosis) when urine is diverted into it. - It is also more prone to **stomal stenosis** and bowel obstruction compared to the ileum. *Colon* - While the colon can be used, particularly in continent diversions, it has a **thicker wall** and can be less mobile, making surgical creation of a conduit more challenging. - Similar to the jejunum, it has a **higher absorptive capacity** than the ileum, which can lead to electrolyte disturbances. *Caecum* - The **caecum** is a possible site for continent urinary diversions (e.g., cecal pouch), but it is not typically used for simple incontinent conduits due to its **anatomical position** and surgical complexity. - Its use often requires additional procedures to ensure continence and prevent reflux.

Q: Which of the following is NOT a standard component of the triple test for breast cancer detection?

Breast self examination. ***Breast self examination*** - While **breast self-examination (BSE)** is important for **personal awareness** and **early detection**, it is not considered a standard component of the diagnostic "triple test" for breast cancer, which aims for definitive diagnosis. - The traditional triple test comprises **clinical examination**, **imaging** (mammography/ultrasound), and **pathological assessment** (FNAC/biopsy). *USG/ mammography* - **Mammography** and **ultrasonography (USG)** are crucial imaging modalities and an integral part of the **triple test**, providing detailed anatomical information about breast lesions. - They help characterize masses detected clinically and guide biopsy procedures, contributing significantly to diagnosis. *FNAC/ trucut biopsy* - **Fine needle aspiration cytology (FNAC)** and **tru-cut biopsy** are essential for **histopathological diagnosis**, confirming malignancy and determining tumor characteristics. - This is the third component of the triple test, providing a definitive cellular or tissue diagnosis. *Clinical examination* - A **thorough clinical breast examination** by a healthcare professional is the first step in the triple test, identifying palpable masses or other suspicious signs. - It involves **inspection** and **palpation** to assess breast tissue and lymph nodes.

Q: Spigelian hernia is

Through lateral border of rectus abdominis. ***Through lateral border of rectus abdominis*** - A **Spigelian hernia** protrudes through the **Spigelian aponeurosis**, which is the aponeurosis of the transversus abdominis muscle, primarily located along the **lateral border of the rectus abdominis muscle**. - Its typical location is often at the **semilunar line**, making it a challenging diagnosis due to its intermittent presentation and potential for strangulation. *Through linea alba* - A hernia through the **linea alba** (midline fibrous structure) is known as an **epigastric hernia** if above the umbilicus, or an **umbilical hernia** if at the umbilicus. - These are distinct from Spigelian hernias which are lateral to the rectus sheath. *Through lateral wall of inguinal canal* - This description typically refers to an **indirect inguinal hernia**, where the contents pass through the **deep inguinal ring**. - This type of hernia travels through the entire inguinal canal and emerges through the superficial ring. *Through medial wall of inguinal canal* - This would describe a **direct inguinal hernia**, which protrudes directly through the posterior wall of the inguinal canal, specifically through **Hesselbach's triangle**. - This is medial to the inferior epigastric vessels, while Spigelian hernias are more superior and lateral.

Q: Ogilvie's syndrome most commonly involves

Cecum and right hemicolon. ***Cecum and right hemicolon*** - Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, primarily affects the **large bowel**. - It most commonly presents with significant dilation of the **cecum and right hemicolon** due to impaired autonomic innervation *Stomach* - The stomach is not typically involved in Ogilvie's syndrome. Conditions affecting the stomach might include **gastroparesis** or **pyloric obstruction**, which have different pathophysiologies. - Ogilvie's syndrome is a disorder of **colonic motility**, not gastric motility. *Gallbladder* - The gallbladder is an organ of the **biliary system** and is not directly affected by Ogilvie's syndrome. - Conditions like **cholecystitis** or **cholelithiasis** involve the gallbladder but are unrelated to acute colonic pseudo-obstruction. *Small intestine* - While pseudo-obstruction can sometimes affect the small intestine (chronic intestinal pseudo-obstruction), Ogilvie's syndrome specifically refers to **acute colonic pseudo-obstruction**. - **Small bowel obstruction** caused by mechanical blockages is a distinct condition with different diagnostic features and management.

Q: A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?

Wound dehiscence. ***Wound dehiscence*** - This is the most likely diagnosis given the presentation of **serous discharge** and a **gap in the wound** on the 5th postoperative day. - **Abdominal intestinal perforation** surgery is a risk factor, and the timing is consistent with **fascial dehiscence**, which can lead to evisceration if left untreated. *Enterocutaneous fistula* - This involves a connection between the **bowel lumen** and the **skin surface**, typically discharging enteric contents (e.g., bile, stool), not just serous fluid. - While a possibility in complicated abdominal surgeries, the description of a "gap in the wound" and serous discharge is more indicative of a **structural failure** of the wound. *Seroma* - A seroma is a collection of **serous fluid** under the skin flap or surgical incision, presenting as a **fluctuant swelling**, but it typically does not involve a "gap in the wound." - It would not usually present with a wound **disruption** that exposes underlying tissue; instead, it's an intact pocket of fluid. *Peritonitis* - This is an **inflammation of the peritoneum**, usually caused by infection, and presents with **severe abdominal pain**, fever, and diffuse tenderness, which are not mentioned here. - While an intestinal perforation would initially cause peritonitis, the current presentation focuses on the **wound site** rather than systemic or diffuse abdominal symptoms.

Q: Which of the following statements about keloids is true?

Local recurrence is common after excision.. ***Local recurrence is common after excision*** - Keloids are characterized by an overgrowth of **scar tissue** that extends beyond the original wound boundaries. - Due to their aggressive fibrous nature and growth factors, **surgical excision alone often leads to recurrence**, sometimes even larger than the original keloid [1]. *They undergo malignant transformation frequently* - Keloids are **benign fibrous growths** and do **not typically undergo malignant transformation**. - While they can be cosmetically distressing and cause symptoms like itching or pain, they are not a precursor to cancer. *They occur equally across all ethnic groups* - Keloids show a significant **predisposition in individuals with darker skin pigmentation**, including those of African, Asian, and Hispanic descent [1]. - This suggests a **genetic component** influencing their occurrence, which is not equally distributed across all ethnic groups [1]. *They remain confined to the original wound boundaries* - This statement describes **hypertrophic scars**, not keloids. - Keloids are specifically defined by their tendency to **grow beyond the margins** of the original injury, invading surrounding healthy skin [1].

Question 1

Epulis arises from -

Accepted Answer

Gingiva

Answer

Enamel

Answer

Root of teeth

Answer

Pulp

Question 2

Migraine is due to

Accepted Answer

Cortical spreading depression

Answer

Dilatation of cranial blood vessels

Answer

Constriction of cranial blood vessels

Answer

Inflammation of the meninges

Question 3

What is the first symptom of leprosy?

Accepted Answer

Decreased pain

Answer

Decreased vibration & position sense

Answer

Decreased temperature

Answer

Decreased light touch

Question 4

Which of the following is not considered a contraindication for pancreaticoduodenectomy?

Accepted Answer

Portal vein involvement

Answer

Metastasis

Answer

Extensive invasion of superior mesenteric vein

Answer

Stage III CA head of pancreas

Question 5

Diversion of urine is best done at

Accepted Answer

Ileum

Answer

Jejunum

Answer

Colon

Answer

Caecum

Question 6

Which of the following is NOT a standard component of the triple test for breast cancer detection?

Accepted Answer

Breast self examination

Answer

USG/ mammography

Answer

Clinical examination

Answer

FNAC/ trucut biopsy

Question 7

Spigelian hernia is

Accepted Answer

Through lateral border of rectus abdominis

Answer

Through linea alba

Answer

Through lateral wall of inguinal canal

Answer

Through medial wall of inguinal canal

Question 8

Ogilvie's syndrome most commonly involves

Accepted Answer

Cecum and right hemicolon

Answer

Stomach

Answer

Gallbladder

Answer

Small intestine

Question 9

A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?

Accepted Answer

Wound dehiscence

Answer

Enterocutaneous fistula

Answer

Peritonitis

Answer

Seroma

Question 10

Which of the following statements about keloids is true?

Accepted Answer

Local recurrence is common after excision.

Answer

They undergo malignant transformation frequently.

Answer

They occur equally across all ethnic groups.

Answer

They remain confined to the original wound boundaries.

NEET-PG 2012

Dental

Internal Medicine

Surgery