NEET-PG 2015 Practice Questions

Q: All of the following are features of Zollinger Ellison syndrome except:

Beta cell tumours of the pancreas. ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.

Q: What is the most common cause of lateral aberrant thyroid tissue?

Metastatic thyroid carcinoma. ***Metastatic thyroid carcinoma*** - **Metastatic papillary thyroid carcinoma** to cervical lymph nodes is the most common cause of lateral aberrant thyroid tissue - The term "lateral aberrant thyroid" is a **historical misnomer** that has been abandoned in modern thyroid surgery - What was previously thought to be ectopic thyroid tissue in lateral neck nodes is virtually always **metastatic disease** - Papillary thyroid carcinoma commonly metastasizes to **regional lymph nodes**, which then contain thyroid follicular cells - This represents **lymph node metastases**, not developmental ectopia *Ectopic thyroid tissue due to developmental anomalies* - True developmental ectopia of thyroid tissue in the **lateral neck is extremely rare to nonexistent** - The thyroid gland originates from the **foramen cecum in the midline** and descends along the thyroglossal duct - Developmental ectopic thyroid occurs in **midline structures** (lingual thyroid, thyroglossal duct remnants), not laterally - The concept of "lateral aberrant thyroid" as a developmental anomaly has been **disproven** *Thyroid tissue in the mediastinum* - Mediastinal thyroid tissue represents **substernal or retrosternal goiter** that has descended into the chest - This describes a different anatomical location (mediastinum vs. lateral neck) - Not related to lateral cervical masses *Lingual thyroid* - Lingual thyroid is ectopic thyroid tissue located at the **base of the tongue** - This is a **midline structure**, not a lateral neck finding - Represents failure of thyroid descent during embryological development

Q: A child presented with blunt abdominal trauma, the first investigation to be done is -

USG. ***USG*** - An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability. - **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**. - It is the **preferred initial investigation in hemodynamically stable pediatric patients**. *CT Scan* - A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children. - It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients. *Complete Hemogram* - A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**. - While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**. *Abdominal X-ray* - An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures. - It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.

Q: Vacuum assisted closure is contraindicated in which of the following conditions -

Large amount of necrotic tissue with eschar. ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.

Q: Which of the following statements is true regarding cystic hygroma?

Develops from jugular lymphatic sequestration. ***Develops from jugular lymphatic sequestration*** - **Cystic hygromas** are congenital **lymphatic malformations** that primarily occur in the neck - They arise from the abnormal budding or sequestration of the **jugular lymph sacs** during embryonic development, leading to the formation of dilated lymphatic channels that fail to connect with the venous system - This is the **most specific and characteristic** feature of cystic hygroma pathogenesis *Non transilluminant* - This statement is **incorrect**; cystic hygromas are typically **transilluminant** because they are fluid-filled sacs - The cystic nature of the lesion allows light to pass through, which is a classic diagnostic feature on clinical examination *Lined by endothelial cells* - While this statement is technically true (lymphatic endothelial cells are a type of endothelial cell), it is **not the most specific answer** - This feature is shared with all vascular and lymphatic structures, making it less distinctive for cystic hygromas - The key distinguishing feature is their **embryological origin** from jugular lymphatic sequestration, not just their endothelial lining *All of the options* - This option is **incorrect** because not all statements are true or most appropriate - Only the statement about jugular lymphatic sequestration represents the most specific and correct answer

Q: Most common site for Cystic Hygroma is -

Lower third of neck. ***Lower third of neck*** - **Cystic hygromas** (also known as **lymphatic malformations**) most commonly occur in the **posterior triangle of the neck**, which is located in the lower lateral aspect of the neck [1]. - Approximately **75-80%** of cystic hygromas are found in the neck region, with the **posterior triangle** being the predominant site. - The **posterior jugular lymph sac** fails to connect properly with the venous system during embryonic development, leading to these cystic malformations in this characteristic location [1]. - The posterior triangle encompasses the lower lateral neck, making "lower third of neck" an acceptable description of this most common site. *Overlying the parotid gland* - While lymphatic malformations can occur in the parotid region, this represents only about **10-15%** of cases. - This is a less common site compared to the posterior triangle of the neck. - Lesions in this area might raise concern for other parotid pathologies like **pleomorphic adenoma** or **hemangioma**. *Along the Zygomatic Prominence* - This is an unusual location for a cystic hygroma, as the lymphatic drainage and embryonic development in this area are not typically associated with these malformations. - Lesions here might suggest different developmental or neoplastic etiologies such as **dermoid cysts** or **vascular malformations**. *Post auricular* - The post-auricular region is not a common site for cystic hygromas. - Swelling in this area could be due to other conditions like **mastoiditis**, **lymphadenopathy**, or **sebaceous cysts**.

Q: The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:

5.5 cm. ***5.5 cm*** - An abdominal aortic aneurysm (AAA) 5.5 cm or larger is typically the threshold for considering **elective surgical repair** due to significantly increased **rupture risk**. - For aneurysms smaller than this, the risk of surgery often outweighs the risk of rupture, making watchful waiting with surveillance more appropriate. *6 cm* - While a 6 cm AAA certainly has a very high risk of rupture, the generally accepted guideline for intervention begins at **5.5 cm** for most patients. - Delaying intervention until 6 cm could unnecessarily expose the patient to a higher risk of rupture. *6.5 cm* - An AAA of 6.5 cm carries an extremely high risk of rupture, and intervention would be strongly indicated. - This size is well past the standard **5.5 cm threshold** recommended for elective repair. *7 cm* - A 7 cm AAA is associated with a **critical and very high risk of rupture**, making immediate intervention imperative. - This size is significantly beyond the established guideline for considering elective repair, which is 5.5 cm.

Q: Chvostek sign could be seen after -

Total Thyroidectomy. ***Total Thyroidectomy*** - A total thyroidectomy involves the removal of the entire thyroid gland, which can inadvertently lead to the removal or damage of the **parathyroid glands** as well. - Damage to the parathyroid glands causes **hypoparathyroidism**, leading to **hypocalcemia**, which is characterized by neuromuscular excitability manifesting as a **Chvostek sign**. *Subtotal Thyroidectomy* - In a subtotal thyroidectomy, only a portion of the thyroid gland is removed, leaving some functional parathyroid tissue intact. - This procedure usually preserves enough parathyroid function to prevent severe **hypocalcemia** and the manifestation of a Chvostek sign. *Heller's Cardiomyotomy* - Heller's cardiomyotomy is a surgical procedure performed to treat **achalasia**, involving the cutting of muscle fibers in the esophagus. - This procedure does not involve the neck region or the parathyroid glands and therefore has no direct association with calcium regulation or the **Chvostek sign**. *Gastrojejunostomy* - A gastrojejunostomy is a surgical procedure that creates a bypass between the stomach and the jejunum, typically performed for conditions like gastric outlet obstruction or as part of bariatric surgery. - This operation is limited to the abdominal cavity and has no direct impact on calcium metabolism or the parathyroid glands that would elicit a **Chvostek sign**.

Q: Reactionary Hemorrhage occurs due to?

Dislodgement of clot. ***Dislodgement of clot*** - **Reactionary hemorrhage** occurs within the first 24 hours post-surgery as the initial **vasoconstriction** and **blood pressure drop** from anesthesia resolve. - As blood pressure normalizes and peripheral vessels dilate, a **clot** that formed in a previously bleeding vessel becomes dislodged, leading to bleeding. *Infection* - **Infection** can cause secondary hemorrhage, but this typically occurs later, usually several days to weeks after surgery, due to tissue necrosis and erosion of blood vessels. - It is not the primary mechanism for hemorrhage occurring within the first 24 hours. *Damage to a blood vessel* - **Damage to a blood vessel** during surgery is a cause of primary hemorrhage, which occurs during or immediately after the procedure. - While it initiates the potential for bleeding, reactionary hemorrhage specifically refers to bleeding that resumes due to changes in patient physiology post-operatively, rather than ongoing vessel damage. *Pressure necrosis* - **Pressure necrosis** refers to tissue death due to sustained external pressure, often leading to skin breakdown or deep tissue injury. - It does not directly cause reactionary hemorrhage, although necrotic tissue could potentially contribute to later secondary hemorrhage if a vessel erodes.

Question 1

All of the following are features of Zollinger Ellison syndrome except:

Accepted Answer

Beta cell tumours of the pancreas

Answer

Severe diarrhoea

Answer

Very high acid output

Answer

Intractable peptic ulcers

Question 2

Which of the following statements about heart transplantation is false?

Accepted Answer

It is only orthotopic and not heterotopic

Answer

High pulmonary arterial resistance is a contraindication

Answer

Immunosuppression is started preoperatively

Answer

A beating heart cadaver/donor is not always needed.

Question 3

What is the most common cause of lateral aberrant thyroid tissue?

Accepted Answer

Metastatic thyroid carcinoma

Answer

Ectopic thyroid tissue due to developmental anomalies

Answer

Thyroid tissue in the mediastinum

Answer

Lingual thyroid

Question 4

A child presented with blunt abdominal trauma, the first investigation to be done is -

Accepted Answer

USG

Answer

CT Scan

Answer

Complete Hemogram

Answer

Abdominal X-ray

Question 5

Vacuum assisted closure is contraindicated in which of the following conditions -

Accepted Answer

Large amount of necrotic tissue with eschar

Answer

Chronic osteomyelitis

Answer

Abdominal wound

Answer

Surgical wound dehiscence

Question 6

Which of the following statements is true regarding cystic hygroma?

Accepted Answer

Develops from jugular lymphatic sequestration

Answer

Non transilluminant

Answer

Lined by endothelial cells

Answer

All of the options

Question 7

Most common site for Cystic Hygroma is -

Accepted Answer

Lower third of neck

Answer

Overlying the parotid gland

Answer

Along the Zygomatic Prominence

Answer

Post auricular

Question 8

The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:

Accepted Answer

5.5 cm

Answer

6 cm

Answer

6.5 cm

Answer

7 cm

Question 9

Chvostek sign could be seen after -

Accepted Answer

Total Thyroidectomy

Answer

Subtotal Thyroidectomy

Answer

Heller's Cardiomyotomy

Answer

Gastrojejunostomy

Question 10

Reactionary Hemorrhage occurs due to?

Accepted Answer

Dislodgement of clot

Answer

Infection

Answer

Damage to a blood vessel

Answer

Pressure necrosis

NEET-PG 2015

Internal Medicine

Surgery