NEET-PG 2013 Practice Questions

Q: Which of the following nerves is commonly damaged during McBurney's incision?

Iliohypogastric nerve. ***Iliohypogastric nerve*** - The **iliohypogastric nerve** is most commonly injured during **McBurney's incision** due to its superficial position and transverse course at the level of the incision. - Damage can lead to **numbness** or altered sensation in the suprapubic region, and sometimes **weakness of the lower abdominal wall**. *Subcostal nerve* - The **subcostal nerve** (T12) runs inferior to the 12th rib and is generally superior to the typical site of a McBurney's incision. - Injury to this nerve is less common during this procedure compared to the iliohypogastric and ilioinguinal nerves. *10th thoracic nerve* - The **10th thoracic nerve** (T10) provides sensation around the umbilicus. - While it contributes to innervation of the abdominal wall, its location is typically well above the area of a standard McBurney's incision, making injury unlikely. *11th thoracic nerve* - The **11th thoracic nerve** (T11) innervates the abdominal wall and is located superior to the typical incision site for appendectomy. - Injury to T11 during a McBurney's incision is uncommon as the nerve's course lies cephalad to the surgical field.

Q: What investigation uses dye to find out stones in the salivary gland?

Sialography. ***Sialography*** - **Sialography** is an imaging technique that involves injecting a **radiopaque dye** into the salivary ducts to visualize the internal structure and identify obstructions like stones (**sialoliths**). - This method allows for detailed imaging of the ductal system, revealing the exact location and size of stones or strictures. *Breast imaging* - **Breast imaging**, such as mammography or ultrasound of the breast, is used to detect abnormalities within the **breast tissue**. - It is completely unrelated to the diagnosis of salivary gland stones. *MR angiography* - **MR angiography (MRA)** is a type of MRI that specifically visualizes **blood vessels** and blood flow throughout the body. - It is used to detect vascular diseases, not obstructions in salivary glands. *USG* - **Ultrasound (USG)** can visualize salivary gland stones, but it does not typically involve the use of an injected dye for this purpose. - While useful for initial screening, **sialography** provides a more detailed view of the ductal system, especially smaller or more complex stones.

Q: Brown tumors are seen in:

Hyperparathyroidism. ***Hypeparathyroidism*** - Brown tumors, also called osteitis fibrosa cystica, are **osteolytic lesions** associated specifically with **hyperparathyroidism** due to increased osteoclastic activity [1][2]. - Elevated levels of **parathyroid hormone (PTH)** lead to bone resorption, giving rise to the characteristic bone changes seen in this condition [1][2]. *Neurofibromatosis* - Neurofibromatosis primarily presents with **neurofibromas**, café-au-lait spots, and skin-related findings, not with brown tumors. - Bone manifestations include **scoliosis** or **plexiform neurofibromas**, but they do not typically lead to brown tumors. *Pigmented villonodular synovitis* - This is a **joint condition** featuring hyperplastic synovial tissue and local joint swelling, but it does not involve **bone changes** typical of brown tumors. - Characterized by **pigmented nodules** in the synovium, it doesn't cause osteolytic lesions seen in hyperparathyroidism. *Osteomalacia* - Osteomalacia is primarily due to **vitamin D deficiency**, leading to softening of the bones, not the formation of **brown tumors**. - It results in bone pain and weakness, with radiological changes such as **Looser's zones** rather than the well-defined lucencies associated with brown tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1105-1106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1194.

Q: What is the most common site for carcinoid tumor?

Ileum. ***Ileum*** - The **ileum** is the most common site for carcinoid tumors, accounting for nearly **50%** of cases [1]. - Carcinoid tumors arise from **neuroendocrine cells** in the gastrointestinal tract, with the ileum being particularly common due to its abundant neuroendocrine tissue [1]. *Appendix* - While carcinoid tumors can occur in the **appendix**, they represent a smaller proportion compared to those found in the ileum. - Typical carcinoid tumors in the appendix are often **asymptomatic** and usually detected incidentally. *Lung* - Though lung carcinoids exist, they represent a different classification of carcinoid tumors, primarily occurring in the **bronchial tree** [2]. - They are less common than those in the gastrointestinal tract, particularly the ileum. *Esophagus* - Carcinoid tumors are rare in the **esophagus** and typically have different presentations compared to gastrointestinal carcinoids. - The esophagus is not a common site for carcinoid tumors, which are primarily found in the intestinal tract. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 727.

Q: The procedure of choice for the evaluation of aortic aneurysms is -

Computed tomography. ***Computed tomography*** - **Computed tomography (CT)** offers excellent spatial resolution and is the gold standard for diagnosing, staging, and pre-operative planning for aortic aneurysms. - It precisely measures aneurysm size, detects mural thrombus, assesses rupture risk, and evaluates the extent of involvement with surrounding structures. *Ultrasonography* - While useful for initial screening and serial monitoring of known abdominal aortic aneurysms due to its non-invasiveness and cost-effectiveness, its accuracy can be limited by **patient body habitus** and **bowel gas**. - It may not reliably visualize the entire aorta or accurately assess complex anatomy and rupture. *Magnetic resonance imaging* - **Magnetic resonance imaging (MRI)** provides detailed anatomical information and avoids radiation exposure, but it is typically more expensive and time-consuming than CT. - It is often reserved for patients with **renal insufficiency** where iodinated contrast is a concern or when evaluating specific tissue characteristics not well seen on CT. *Arteriography* - **Arteriography** (angiography) is an invasive procedure involving direct contrast injection, carrying risks such as arterial injury and nephrotoxicity. - While it can visualize the aortic lumen, it primarily shows the patent lumen and may **underestimate the true aneurysm size** due to mural thrombus. It is typically used for intervention planning or specific contexts rather than initial diagnosis.

Q: Treatment for ileal obstruction due to roundworm infestation is

Enterotomy, removal of worms and primary closure. ***Enterotomy, removal of worms and primary closure*** - For **ileal obstruction** by **roundworms**, **surgical intervention** involves opening the affected bowel segment (**enterotomy**), carefully extracting the worm bolus, and then closing the incision primarily. - This approach is favored because the bowel itself is usually **healthy**, and the obstruction is purely mechanical from the worms. *Resection with end to end anastomosis* - This aggressive approach of **resecting** part of the bowel is generally **unnecessary** and **risky** when the bowel is otherwise healthy and viable, as is typical in roundworm obstruction. - It carries risks of **anastomotic leakage** and **short gut syndrome** if repeated resections are needed, making simple worm removal a preferable option. *Resection with side to side anastomosis* - Similar to end-to-end anastomosis, **resection** of the bowel is generally avoided unless there is **irreversible damage** or **ischemia** to the bowel, which is not the primary pathology in uncomplicated roundworm obstruction. - This method is more complex and less optimal than simply removing the obstruction, given the typically *healthy* nature of the bowel wall. *Diversion* - **Diversion** procedures, such as **stoma formation**, are generally reserved for situations with **perforation**, **gross contamination**, or complex obstructions where primary repair is considered unsafe or impossible. - In a straightforward ileal obstruction due to worms, the goal is to resolve the obstruction with minimal intervention to preserve bowel continuity.

Q: Among the following single parameters, malnutrition in surgical patients is best assessed by:

Mid arm circumference. ***Mid arm circumference*** - **Mid-arm circumference (MAC)** is considered a reliable and easily measurable single parameter for assessing malnutrition, as it reflects both **muscle mass** and **subcutaneous fat**. - It is particularly useful in surgical patients where rapid and practical assessment of nutritional status is needed. *Serum albumin* - While **serum albumin** reflects visceral protein status, its levels can be significantly affected by **hydration status**, inflammation, and liver disease, making it less specific for malnutrition in acute surgical settings. - Due to its **long half-life**, serum albumin may not accurately reflect recent changes in nutritional status. *Hb level* - **Hemoglobin (Hb) levels** primarily assess anemia, which can be caused by various factors beyond malnutrition, such as blood loss or chronic disease. - Anemia does not directly measure or reflect overall protein-energy malnutrition. *Triceps skin fold thickness* - **Triceps skin fold thickness (TSFT)** measures subcutaneous fat stores but does not provide information about lean muscle mass or overall protein status. - Its measurement can be less accurate due to inter-observer variability and may not reflect comprehensive malnutrition as well as MAC.

Q: Indication for sentinel node biopsy is:

Non-palpable axillary lymph node. ***Non-palpable axillary lymph node*** - **Sentinel lymph node biopsy (SLNB)** is indicated when there is no clinical evidence of axillary lymph node involvement, meaning the nodes are **non-palpable**. - Its purpose is to identify micrometastases that would not be detectable by physical examination, staging the cancer more accurately and guiding further treatment. *Palpable axillary lymph node* - A **palpable axillary lymph node** suggests macroscopic nodal involvement, usually requiring a fine needle aspiration (FNA) or core needle biopsy for diagnosis. - If positive, these patients typically proceed directly to **axillary lymph node dissection (ALND)** rather than SLNB. *Mass > 5 cm* - The size of the primary tumor (e.g., > 5 cm) is a factor in staging but does not, in itself, preclude or indicate SLNB. - While larger tumors have a higher risk of nodal involvement, the decision for SLNB still hinges on the clinical status of the axilla (palpable vs. non-palpable nodes). *Metastasis* - If **distant metastasis** is confirmed, the focus shifts to palliative care and systemic treatment, making a regional staging procedure like SLNB less relevant or unnecessary. - SLNB is used for staging early-stage cancer to detect regional spread, not when widespread disease is already established.

Q: Which one of the following is used as a preservative for packing catgut suture?

Isopropyl alcohol. ***Isopropyl alcohol*** - **Isopropyl alcohol** is commonly used as a preservative for **catgut sutures** due to its antiseptic and denaturing properties that prevent microbial growth and maintain the integrity of the biologic material. - It helps to keep the suture sterile and prevents degradation by enzymes or bacteria during storage. *Colloidal iodine* - **Colloidal iodine** is an antiseptic, but it is not typically used as a preservative for **catgut sutures**; it is more often used for skin preparation or wound disinfection. - Its reactivity and potential to stain or alter **suture material** make it less suitable for long-term preservation within the packaging. *Glutaraldehyde* - **Glutaraldehyde** is a potent disinfectant and sterilant, but it is generally too harsh for preserving **catgut sutures**; it can cause significant cross-linking and denaturation of proteins. - It is more commonly used for sterilizing heat-sensitive medical instruments like **endoscopes**, rather than for preserving **suture materials**. *Hydrogen peroxide* - **Hydrogen peroxide** is an oxidizing agent used as an antiseptic to clean wounds or as a sterilant, but it is not suitable for preserving **catgut sutures**. - Its oxidative action could degrade the **collagenous material** of the suture, compromising its strength and absorption properties.

Q: Which of the following is NOT a feature of Cushing's triad?

Hypotension. ***Hypotension*** - Cushing's triad is an indicator of **increased intracranial pressure (ICP)** and classically presents with **hypertension**, not hypotension. - Hypotension would suggest a different problem, such as **spinal shock** or **hypovolemia**, which are not directly associated with Cushing's triad. *Bradycardia* - **Bradycardia** is a key component of Cushing's triad, resulting from vagal stimulation due to increased intracranial pressure. - This reflex reduces heart rate in an attempt to maintain cerebral perfusion. *Hypertension* - **Hypertension**, specifically a widened pulse pressure, is a cardinal feature of Cushing's triad, caused by systemic vasoconstriction to overcome increased ICP and maintain **cerebral perfusion pressure**. - It is a compensatory mechanism to push blood into the brain. *Irregular breathing* - **Irregular breathing patterns**, such as Cheyne-Stokes respiration or ataxic breathing, are characteristic of Cushing's triad, indicating brainstem compression [1]. - This irregular respiratory effort is due to direct pressure on the **respiratory centers** in the medulla [1].

Question 1

Which of the following nerves is commonly damaged during McBurney's incision?

Accepted Answer

Iliohypogastric nerve

Answer

Subcostal nerve

Answer

11th thoracic nerve

Answer

10th thoracic nerve

Question 2

What investigation uses dye to find out stones in the salivary gland?

Accepted Answer

Sialography

Answer

MR angiography

Answer

USG

Answer

Breast imaging

Question 3

Brown tumors are seen in:

Accepted Answer

Hyperparathyroidism

Answer

Pigmented villonodular synovitis

Answer

Osteomalacia

Answer

Neurofibromatosis

Question 4

What is the most common site for carcinoid tumor?

Accepted Answer

Ileum

Answer

Lung

Answer

Esophagus

Answer

Appendix

Question 5

The procedure of choice for the evaluation of aortic aneurysms is -

Accepted Answer

Computed tomography

Answer

Magnetic resonance imaging

Answer

Arteriography

Answer

Ultrasonography

Question 6

Treatment for ileal obstruction due to roundworm infestation is

Accepted Answer

Enterotomy, removal of worms and primary closure

Answer

Resection with end to end anastomosis

Answer

Resection with side to side anastomosis

Answer

Diversion

Question 7

Among the following single parameters, malnutrition in surgical patients is best assessed by:

Accepted Answer

Mid arm circumference

Answer

Triceps skin fold thickness

Answer

Hb level

Answer

Serum albumin

Question 8

Indication for sentinel node biopsy is:

Accepted Answer

Non-palpable axillary lymph node

Answer

Palpable axillary lymph node

Answer

Metastasis

Answer

Mass > 5 cm

Question 9

Which one of the following is used as a preservative for packing catgut suture?

Accepted Answer

Isopropyl alcohol

Answer

Colloidal iodine

Answer

Glutaraldehyde

Answer

Hydrogen peroxide

Question 10

Which of the following is NOT a feature of Cushing's triad?

Accepted Answer

Hypotension

Answer

Hypertension

Answer

Bradycardia

Answer

Irregular breathing

NEET-PG 2013

Anatomy

Dental

Pathology

Radiology

Surgery