Internal Medicine
1 questionsAll of the following are causes of hemobilia, EXCEPT:
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 911: All of the following are causes of hemobilia, EXCEPT:
- A. Trauma to Abdomen
- B. Hepatitis (Correct Answer)
- C. Rupture of hepatic artery aneurysm
- D. Malignancy
Explanation: ***Hepatitis*** - **Hepatitis** is an inflammation of the liver, typically caused by viral infections, alcohol, or autoimmune processes. While it can lead to liver damage and dysfunction, it does not typically cause **hemobilia**. - **Hemobilia** involves bleeding into the biliary tree, which is usually a result of vascular-biliary fistula formation; hepatitis primarily affects liver parenchymal cells and does not directly result in this type of bleeding. *Trauma to Abdomen* - **Abdominal trauma**, especially liver injuries, can lead to **vascular-biliary fistulae** or direct bleeding into the bile ducts, causing **hemobilia**. - Blunt or penetrating trauma can damage the liver parenchyma and blood vessels, allowing blood to enter the biliary system. *Malignancy* - **Malignant tumors** of the liver or biliary tract (e.g., **cholangiocarcinoma**, **hepatocellular carcinoma**) can erode into blood vessels and bile ducts, leading to **hemobilia**. - The growth of these tumors can rupture fragile vessels within the tumor or adjacent to it, causing blood to leak into the biliary tree. *Rupture of hepatic artery aneurysm* - A ruptured **hepatic artery aneurysm** is a significant and direct cause of **hemobilia**. - The forceful bleeding from the artery can breach the wall of an adjacent bile duct, creating a **fistula** and allowing arterial blood to enter the biliary system.
Pediatrics
3 questionsAt what age can children typically draw a square?
At what age can an infant typically achieve head control or neck holding?
At what age (year) do arm span and height become the same?
NEET-PG 2013 - Pediatrics NEET-PG Practice Questions and MCQs
Question 911: At what age can children typically draw a square?
- A. 5 years (Correct Answer)
- B. 3 years
- C. 6 years
- D. 7 years
Explanation: ***5 years*** - At 5 years old, children have developed the **fine motor skills** and **cognitive abilities** necessary to copy and draw a square independently. - This is a key developmental milestone reflecting improved **visual-motor coordination** and understanding of geometric shapes with corners and angles. - By this age, children can also draw recognizable human figures with multiple body parts. *3 years* - While 3-year-olds can copy a circle and draw vertical/horizontal lines, they typically lack the **fine motor precision** and spatial understanding to draw a square with four equal sides and right angles. - Their drawings of angular shapes are crude approximations or scribbles rather than recognizable squares. *6 years* - By 6 years of age, children are proficient at drawing squares and other basic shapes, and are beginning to draw more complex figures with **perspective** and greater detail. - This age represents refinement beyond the initial mastery of drawing a square, which typically occurs at 5 years. *7 years* - At 7 years old, children have long mastered drawing basic shapes like squares and are capable of drawing objects with **depth and perspective** using multiple shapes, lines, and colors. - They demonstrate more advanced artistic expression and detailed representations.
Question 912: At what age can an infant typically achieve head control or neck holding?
- A. 1 month
- B. 2 months
- C. 3 months (Correct Answer)
- D. 6 months
Explanation: ***3 months*** - By **3 months** of age, an infant typically develops sufficient **neck muscle strength** and control to hold their head steady when sitting upright or pulled to a sit. - This milestone indicates maturation of the **cervical muscles** and nervous system coordination necessary for head stability. *1 month* - At **1 month**, an infant usually has very little head control and their head will **lag significantly** when pulled to a sitting position. - Neck muscles are still relatively weak, and the infant is unable to maintain the head in an upright posture against gravity. *2 months* - While some improvement in head control may be observed around **2 months**, the infant's head will still generally **wobble** and lag when moved. - Sustained, steady head holding is not typically achieved at this age, and support is still largely required. *6 months* - By **6 months**, an infant should have **excellent head control** and be able to easily hold their head steady and upright. - This age marks the development of other motor milestones like sitting with support or independently, which require strong neck and core muscles.
Question 913: At what age (year) do arm span and height become the same?
- A. 9
- B. 11 (Correct Answer)
- C. 13
- D. 15
Explanation: ***11*** - At approximately **11 years of age**, the arm span and height of an average individual become equal. - This equality is a **developmental milestone** often observed during childhood growth. *9* - At **9 years of age**, an individual's **arm span** is typically **less than their height**, as the extremities are still growing in proportion to the trunk. - The limbs are still developing, and the ratio of limb length to trunk length hasn't yet reached parity. *13* - By **13 years of age**, in most individuals, the **arm span generally exceeds the height**, especially during the adolescent growth spurt. - This is often a period of rapid growth where the limbs may grow faster than the trunk, leading to disproportion. *15* - At **15 years of age**, the **arm span typically continues to be greater than the height**, reflecting the fully developed adult proportions for most individuals. - Adult proportions, where arm span often slightly exceeds height, are typically established by this age.
Physiology
1 questionsWhich of the following is the principal mode of heat exchange in an infant incubator?
NEET-PG 2013 - Physiology NEET-PG Practice Questions and MCQs
Question 911: Which of the following is the principal mode of heat exchange in an infant incubator?
- A. Radiation
- B. Evaporation
- C. Convection (Correct Answer)
- D. Conduction
Explanation: ***Convection*** - In an infant incubator, **convection** is the primary method of heat transfer where a fan circulates warm air around the infant. - This controlled circulation of warm air helps maintain a stable thermal environment for the neonate. *Radiation* - **Radiation** involves heat transfer through electromagnetic waves, and while it occurs, it's not the primary mode in a typical closed incubator, which aims to minimize radiant heat loss to cooler surfaces. - Radiant warmers, used for open care, primarily rely on radiation, but these are distinct from closed incubators. *Evaporation* - **Evaporation** is the loss of heat through the conversion of liquid (sweat or insensible water loss) to vapor, but incubators aim to minimize this by maintaining optimal humidity. - Excessive evaporative heat loss can be significant in premature infants, but it is a mode of *heat loss*, not the principal *mode of heat exchange* for maintaining warmth in an incubator. *Conduction* - **Conduction** is direct heat transfer through physical contact, such as between the infant's skin and the mattress. - While incubators have warm mattresses to prevent conductive heat loss, the circulating warm air (convection) is the main mechanism for overall temperature control.
Surgery
5 questionsWhich of the following conditions is not typically treated with a simple mastectomy?
Commonest site of carcinoma tongue -
In which of the following conditions is ERCP not indicated?
In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?
Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 911: Which of the following conditions is not typically treated with a simple mastectomy?
- A. Paget's disease
- B. Fibroadenoma (Correct Answer)
- C. Cystosarcoma phyllodes
- D. None of the options
Explanation: ***Fibroadenoma*** - A **fibroadenoma** is a **benign tumor** of the breast that typically does not require a mastectomy for treatment. - Treatment usually involves **observation**, **excision**, or **cryoablation**, depending on size, symptoms, and patient preference. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that affects the nipple and areola, and is typically associated with an underlying **ductal carcinoma in situ** (DCIS) or **invasive breast cancer**. - Due to the presence of malignancy and its superficial spread, **mastectomy** (simple or modified radical) is often the recommended treatment, especially for extensive disease. *Cystosarcoma phyllodes* - Formerly known as **phyllodes tumor**, this is a rare **stromal tumor** of the breast that can be benign, borderline, or malignant. - Due to its potential for local recurrence and, in malignant cases, metastasis, **wide local excision with clear margins** is crucial, and a **simple mastectomy** may be necessary for large or recurrent tumors to achieve adequate margin control. *None of the options* - This option is incorrect because fibroadenoma is a condition not typically treated with a simple mastectomy, unlike Paget's disease and cystosarcoma phyllodes.
Question 912: Commonest site of carcinoma tongue -
- A. Apical
- B. Lateral borders (Correct Answer)
- C. Dorsum
- D. Posterior 1/3
Explanation: ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.
Question 913: In which of the following conditions is ERCP not indicated?
- A. Distal CBD tumor
- B. Hepatic porta tumor
- C. Proximal cholangiocarcinoma (Correct Answer)
- D. Gall stone pancreatitis
Explanation: ***Proximal cholangiocarcinoma*** - For **proximal/hilar cholangiocarcinoma** (Klatskin tumors at the **hepatic hilum**), **PTBD (Percutaneous Transhepatic Biliary Drainage)** is generally preferred over ERCP for biliary drainage. - The **high location** of these tumors makes endoscopic access difficult, with lower success rates and higher risk of complications like **cholangitis** and incomplete drainage. - **ERCP may fail** to adequately drain both hepatic ducts in bifurcation tumors, making PTBD the more reliable first-line approach. *Hepatic porta tumor* - **Hepatic porta tumors** involving the bile ducts are anatomically similar to **proximal cholangiocarcinoma**. - While ERCP can occasionally be attempted for porta hepatis lesions, **PTBD is often preferred** for high biliary obstructions due to better access to intrahepatic ducts. - The distinction is subtle, but **proximal cholangiocarcinoma** specifically refers to Klatskin tumors where ERCP has the **highest failure rate** and PTBD is most strongly preferred. *Distal CBD tumor* - **ERCP is the preferred modality** for **distal CBD tumors** to provide **biliary drainage**, tissue sampling (biopsy), and stent placement to relieve obstruction. - Direct endoscopic access to the distal common bile duct makes ERCP highly effective for diagnosis and palliation in this region. *Gallstone pancreatitis* - **ERCP is indicated** in **gallstone pancreatitis** when there is evidence of **cholangitis** or persistent **biliary obstruction** (e.g., rising liver enzymes, imaging showing retained stone in the CBD). - It allows for **therapeutic removal of impacted stones** from the common bile duct, preventing further pancreatic inflammation and complications.
Question 914: In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?
- A. 6 hr (Correct Answer)
- B. 12 hr
- C. 24 hr
- D. 1 week
Explanation: ***6 hr*** - Testicular viability is highest when **detorsion** occurs within **6 hours** of symptom onset. - Delay beyond this timeframe significantly increases the risk of **testicular ischemia** and necrosis. *12 hr* - While some viability may remain, the probability of **testicular salvage** decreases substantially after 6 hours. - Testicular function, including **sperm production**, is often compromised even if the testis is saved. *24 hr* - Beyond 12-24 hours, the likelihood of **testicular viability** is very low, and **orchiectomy** (testicle removal) is often necessary. - Prolonged ischemia leads to irreversible **tissue damage** and infarction. *1 week* - After one week, the testis is almost certainly non-viable due to **prolonged ischemia** and necrosis. - This delay would invariably result in the need for **orchiectomy**.
Question 915: Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?
- A. Carcinoma
- B. Hernia
- C. Hematoma (Correct Answer)
- D. Torsion
Explanation: ***Hematoma*** - A history of **trauma** leading to a **swollen and erythematous testis** is highly indicative of a testicular hematoma. Trauma can cause bleeding within the scrotal sac, leading to the observed symptoms. - A hematoma is a localized collection of **blood outside of blood vessels**, which in this case, results from the injury to the testis or surrounding structures. *Torsion* - Testicular torsion typically presents with **sudden, severe pain** and swelling, and can be associated with absent **cremasteric reflex**. While swelling is present, the clear history of trauma points away from spontaneous torsion. - Torsion is an **emergency** caused by the twisting of the spermatic cord, which **cuts off blood supply** to the testis, and usually lacks a direct antecedent trauma. *Carcinoma* - Testicular carcinoma usually presents as a **painless, firm mass** within the testis. Pain can occur if there is hemorrhage within the tumor or rapid growth. - While it can cause swelling, the acute onset and direct association with trauma make carcinoma less likely, as it is a **slowly progressive** condition. *Hernia* - An inguinal hernia typically presents as a **groin bulge** that can extend into the scrotum, and usually reduces with manipulation or lying down. It is often associated with a cough or strain. - While a hernia can cause scrotal swelling, the primary presentation is usually a reducible mass, and the direct link to trauma with associated erythema is not typical for a simple hernia.