Internal Medicine
3 questionsWhich of the following is NOT a common complication of acute pancreatitis?
A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1111: Which of the following is NOT a common complication of acute pancreatitis?
- A. Subcutaneous fat necrosis
- B. Hyperlipidemia
- C. Hypercalcemia (Correct Answer)
- D. Increased amylase level
Explanation: ***Hypercalcemia*** - Acute pancreatitis is primarily associated with **increased amylase levels** and **hyperlipidemia**, while hypercalcemia is generally a separate condition. - It is not a classical complication or result of acute pancreatitis, but rather might be a cause in cases like **hyperparathyroidism** [1]. *Subcutaneous fat necrosis* - This occurs as a result of **lipolysis** during acute pancreatitis due to the release of **lipases** into circulation [1]. - It is characterized by the presence of **fat necrosis** on the abdomen or buttocks. *Increased amylase level* - A hallmark of acute pancreatitis is **elevated levels of amylase** and sometimes lipase, indicating pancreatic inflammation [1]. - The rise typically occurs within the first 24 hours of the onset of pancreatitis. *Hyperlipidemia* - This is often found in acute pancreatitis due to excess **lipolysis**, leading to elevated triglycerides in the blood [1]. - It can be both a cause and a consequence of pancreatic inflammation, contributing to the disease process [1].
Question 1112: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
- A. Serum GGT (Correct Answer)
- B. Serum LDH
- C. Base deficit
- D. Age
Explanation: ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.
Question 1113: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:
- A. Splenic Vein Thrombosis (Correct Answer)
- B. Bleeding
- C. Gastric Outlet Obstruction
- D. Perforation
Explanation: ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.
Pediatrics
1 questionsAll of the following are clinical features suggestive of tracheoesophageal fistula except -
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1111: All of the following are clinical features suggestive of tracheoesophageal fistula except -
- A. Fever (Correct Answer)
- B. Choking and Coughing
- C. Regurgitation
- D. Cyanosis
Explanation: ***Fever*** - **Fever is NOT a primary clinical feature** of tracheoesophageal fistula (TEF) itself. - While fever might occur as a **complication** if aspiration pneumonia develops, it is not a direct presenting sign of TEF. - The classic presentation of TEF occurs in **newborns within hours of birth** and involves the "3 Cs" - not fever. *Choking and Coughing* - Part of the classic **"3 Cs" triad** (Choking, Coughing, Cyanosis) of TEF presentation. - Occurs during the **first feeding attempt** when milk enters the trachea through the abnormal fistulous connection. - This is a **cardinal diagnostic feature** that should immediately raise suspicion for TEF. *Regurgitation* - **Immediate regurgitation** of feeds is characteristic, especially in TEF with esophageal atresia (most common type - Type C). - The **blind-ending proximal esophageal pouch** prevents normal passage of saliva and feeds, causing regurgitation. - Often accompanied by **excessive drooling and frothy secretions** from the mouth and nose. *Cyanosis* - The third component of the **"3 Cs" triad** and a key clinical feature. - Results from **aspiration of feeds or saliva** into the trachea and lungs, causing acute respiratory distress. - May also occur from **laryngospasm** as a protective reflex when fluid enters the airway.
Surgery
6 questionsWhich of the following statements about Hirschsprung disease is incorrect?
Among pathological lead points, the commonest cause of intussusception is -
What is the most important presenting feature of periampullary carcinoma?
What is the best marker to assess prognosis after surgery for colon carcinoma?
All of the following are surgical options in the management of esophageal carcinoma except -
RPLND and Chemotherapy may be used in management of?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1111: Which of the following statements about Hirschsprung disease is incorrect?
- A. The non-peristaltic affected segment is dilated (Correct Answer)
- B. Absence of ganglion cells in the involved segment
- C. Mainly presents in infancy
- D. Swenson, Duhamel, and Soave are surgical procedures for this condition
Explanation: ***The non-peristaltic affected segment is dilated*** - In Hirschsprung disease, the **aganglionic segment** is typically **constricted** and **narrow**, not dilated, due to continuous contraction without relaxation. - The healthy colon proximal to the affected segment becomes dilated due to the obstruction caused by the constricted, aganglionic segment. *Absence of Ganglion cells in the involved segment* - This statement is **correct**. Hirschsprung disease is fundamentally characterized by the **absence of intramural ganglion cells** (Meissner and Auerbach plexuses) in a segment of the distal colon. - This aganglionosis results in a failure of relaxation and normal peristalsis in the affected bowel segment. *Swenson, Duhamel, and Soave are surgical procedures for this condition* - This statement is **correct**. These are the classic and most common **pull-through surgical procedures** used to treat Hirschsprung disease. - They involve resecting the aganglionic segment and pulling the normal, ganglionated bowel down to the anus. *Mainly presents in infancy* - This statement is **correct**. Hirschsprung disease is primarily a **congenital condition** and is typically diagnosed in newborns and infants. - Common presenting symptoms include **failure to pass meconium** within the first 24-48 hours of life, abdominal distension, and bilious vomiting.
Question 1112: Among pathological lead points, the commonest cause of intussusception is -
- A. Submucous lipoma
- B. Meckel's diverticulum (Correct Answer)
- C. Polyp
- D. Hypertrophy of submucous peyer's patches
Explanation: ***Meckel's diverticulum*** - Among **pathological lead points** specifically, **Meckel's diverticulum** is the most common cause of intussusception. - It is a true congenital diverticulum that can act as a lead point when it becomes inverted, inflamed, or has associated ectopic tissue or tumors. - While overall intussusception in children is mostly idiopathic, when a **pathological lesion** is identified, Meckel's diverticulum is the leading cause. - Seen in approximately 2% of the population, it follows the "rule of 2s" and is the most frequent anatomical abnormality causing pathological intussusception in pediatric patients. *Hypertrophy of submucous Peyer's patches* - **Peyer's patch hypertrophy** is the most common cause of intussusception **overall** in children (90% of cases), typically following viral infections. - However, this represents **idiopathic intussusception**, not a true pathological lead point, as no discrete anatomical lesion is identified. - The question specifically asks for pathological lead points, which excludes this idiopathic mechanism. *Submucous lipoma* - A **submucous lipoma** can serve as a pathological lead point for intussusception, but is much rarer. - More commonly seen in adults rather than children. - While it is a true pathological lesion, it is less frequent than Meckel's diverticulum as a lead point. *Polyp* - **Polyps** (adenomatous, hamartomatous, or inflammatory) can act as pathological lead points. - More common in adults and in specific syndromes (e.g., Peutz-Jeghers syndrome). - Less frequent than Meckel's diverticulum among pathological causes in the pediatric population.
Question 1113: What is the most important presenting feature of periampullary carcinoma?
- A. Jaundice (Correct Answer)
- B. Abdominal Pain
- C. Unintentional Weight Loss
- D. Palpable Abdominal Mass
Explanation: ***Jaundice*** - **Painless obstructive jaundice** is the hallmark symptom, occurring early due to the tumor's proximity to the common bile duct. - The obstruction of bile flow leads to the accumulation of **bilirubin**, causing yellow discoloration of the skin and eyes. *Abdominal Pain* - While **abdominal pain** can occur, it is often a later symptom and is less specific than jaundice for early diagnosis. - Pain typically arises from tumor growth, invasion of surrounding structures, or pancreatic involvement. *Unintentional Weight Loss* - **Unintentional weight loss** is a common constitutional symptom of many advanced malignancies, including periampullary carcinoma. - However, it usually manifests at a later stage and is not the initial, specific presenting feature that prompts investigation. *Palpable Abdominal Mass* - A **palpable abdominal mass** is rare in early periampullary carcinoma, as these tumors are typically small and deeply seated. - Its presence usually indicates advanced disease with significant tumor burden or metastasis.
Question 1114: What is the best marker to assess prognosis after surgery for colon carcinoma?
- A. CA 19-9
- B. CA-125
- C. Alpha fetoprotein
- D. CEA (Correct Answer)
Explanation: ***CEA*** - Carcinoembryonic antigen (**CEA**) is a well-established tumor marker for monitoring colorectal cancer post-surgery and assessing prognosis [1]. - Elevated **CEA levels** after surgery may indicate recurrence or residual disease, making it valuable in follow-up care [1]. *CA 19-9* - Primarily associated with **pancreatic** and **biliary tract cancers**, and not specific for colon carcinoma. - While it may elevate in some gastrointestinal malignancies, it is not the best indicator for prognosis after colon cancer surgery. *Alpha fetoprotein* - Mostly used for monitoring **hepatocellular carcinoma** and germ cell tumors, not colorectal malignancies. - Elevated levels are not typically correlated with prognosis in colon cancer patients. *CA-125* - Mainly utilized as a tumor marker for **ovarian cancer** and some other malignancies, not specifically for colon carcinoma. - Its use in colorectal cancer prognosis is limited and lacks relevance in this context. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 253-254.
Question 1115: All of the following are surgical options in the management of esophageal carcinoma except -
- A. Ivor Lewis Approach
- B. McKeown's Approach
- C. Transhiatal removal
- D. Sistrunk operation (Correct Answer)
Explanation: ***Sistrunk operation*** - The **Sistrunk operation** is a surgical procedure specifically designed for the removal of a **thyroglossal duct cyst**, not for esophageal carcinoma. - This procedure involves excising the cyst along with the central portion of the hyoid bone and the tract leading to the foramen cecum to prevent recurrence. *Ivor Lewis Approach* - The **Ivor Lewis approach** is a common and established surgical technique for **esophagectomy**, involving both abdominal and right thoracic incisions for tumor resection and reconstruction. - It is often used for tumors in the mid to distal esophagus. *Mckeown's Approach* - The **McKeown's approach** is another well-known surgical technique for **esophagectomy**, typically used for more proximal esophageal tumors. - This involves three incisions: abdominal, right thoracic, and cervical, allowing for extensive lymphadenectomy. *Transhiatal removal* - **Transhiatal esophagectomy** is a surgical option for esophageal cancer that involves abdominal and cervical incisions without a thoracic incision. - This approach is often favored in patients with significant comorbidities who may not tolerate a full thoracotomy.
Question 1116: RPLND and Chemotherapy may be used in management of?
- A. Non-seminomatous germ cell tumors of the testis (Correct Answer)
- B. Non-germ cell tumors
- C. Seminomatous germ cell tumors
- D. Lymphoma of the testis
Explanation: ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.