NEET-PG 2015 Practice Questions

Q: Food can commonly get obstructed in the esophagus at all of the following locations except

Crossing of the hemiazygous vein. Food can commonly get obstructed in the esophagus at all of the following locations except ***Crossing of the hemiazygous vein*** - The **hemiazygos vein crosses the vertebral column** at T7-T9 to drain into the azygos vein; however, this anatomical relationship does not typically create a constriction or point of obstruction for the esophagus. - While it is in proximity, its course does not physically compress or narrow the esophageal lumen in a manner that would commonly cause food impaction. *Crossing of left bronchus* - The **left main bronchus crosses anterior to the esophagus** at the level of the carina (T4-T5), causing a natural indentation and narrowing of the esophageal lumen. - This anatomical narrowing, coupled with the rigid structure of the bronchus, makes it a common site for food impaction, especially for larger boluses. *Crossing of arch of aorta* - The **arch of the aorta crosses anterior and to the left of the esophagus** at the level of T3-T4, creating another significant anatomical constriction. - This bending and compression by a large, typically pulsatile vessel forms a natural bottleneck where swallowed food can easily become lodged. *Diaphragmatic aperture* - The **esophageal hiatus of the diaphragm** (T10) is the most distal natural esophageal narrowing, where the esophagus passes through a muscular opening before joining the stomach. - This narrow opening, surrounded by the crura of the diaphragm, is a very common site for food impaction, particularly when the opening is physiologically or pathologically narrowed (e.g., in cases of hiatal hernia or tight diaphragmatic attachments).

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

H. Pylori infection is a known risk factor. ***H. Pylori infection is a risk factor*** - MALToma, or **mucosa-associated lymphoid tissue lymphoma**, is often associated with chronic **H. Pylori infection**, making it a significant risk factor [1]. - **Eradication of H. Pylori** can lead to regression of MALT lymphoma, further supporting the association. *They are a type of T cell lymphoma* - MALToma is classified as a **B-cell lymphoma**, primarily arising from **marginal zone B cells** [1]. - T-cell lymphomas differ significantly in their **pathophysiology** and typical clinical presentations. *They are secondary gastric lymphomas* - MALTomas typically arise **primarily** in the gastric mucosa rather than as secondary lymphomas from another site [1]. - Secondary lymphomas are usually related to more aggressive forms and are often associated with **systemic involvement**. *Commonly seen in gastric cardia* - MALTomas are most frequently found in the **stomach** but are not specifically concentrated in the **gastric cardia** region. - They can also manifest in other areas such as the **antrum**, making this statement misleading. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-358.

Q: In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?

Cholesterolosis of the gallbladder. ***Cholesterolosis of the gallbladder*** - This condition is characterized by the accumulation of **cholesterol esters** and **triglycerides** within macrophages in the lamina propria of the gallbladder, creating a **speckled appearance** often referred to as a "**strawberry gallbladder**". - It is typically asymptomatic but can be associated with **cholelithiasis** (gallstones) in some cases. *Gangrene of the gallbladder* - This is a severe complication of **acute cholecystitis** where the gallbladder tissue dies due to **ischemia**, often appearing necrotic and dark, not speckled. - It presents with severe abdominal pain, fever, and signs of **sepsis**, which is distinct from a speckled appearance. *Porcelain gallbladder* - This condition involves **extensive calcification of the gallbladder wall**, making it brittle and rigid, and is often associated with an increased risk of gallbladder cancer. - Its appearance is typically hard and white due to calcification, not speckled like a strawberry. *Adenomatosis of the gallbladder* - This term is often used interchangeably with **adenomyomatosis**, which involves **hypertrophy of the muscularis propria** and **outpouchings of the mucosa** (Rokitansky-Aschoff sinuses). - It presents as nodular or diffuse thickening of the gallbladder wall, not a speckled mucosal pattern.

Q: What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?

CT scan. ***CT scan*** - **CT scan** with contrast is the gold standard for diagnosing renal cell carcinoma and evaluating the extent of tumor thrombus into the **IVC**. - It provides detailed anatomical information on the tumor, staging, and involvement of adjacent structures. *Angiography* - **Angiography** is an invasive procedure primarily used for mapping the vascular supply of the tumor preoperatively or for embolization, not as a primary diagnostic tool. - It carries risks associated with contrast agents and catheterization and provides less comprehensive detail on tumor extension compared to CT. *Colour doppler imaging* - While useful for detecting blood flow and confirming the presence of a thrombus, **color Doppler imaging** (ultrasound) has limitations in accurately assessing the cranial extent of an IVC thrombus. - Its diagnostic accuracy is highly operator-dependent and less reliable for deep structures like the IVC compared to CT. *IVP* - **Intravenous Pyelogram (IVP)** assesses the urinary tract's structure and function but has limited utility in detecting soft tissue masses like renal cell carcinoma or IVC thrombus. - It involves radiation exposure and contrast material, and has largely been replaced by more advanced imaging techniques like CT and MRI for renal masses.

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.

Q: Transplanted kidney is relocated to which region in the recipient's body?

Retroperitoneal region. ***Retroperitoneal region*** - The transplanted kidney is typically placed in the **iliac fossa** within the **retroperitoneal space** of the recipient [2]. - This location provides adequate space and a convenient site for connecting the transplant's renal artery and vein to the recipient's **iliac vessels**, and the ureter to the bladder [2]. *Lumbar region* - The native kidneys are located in the lumbar region, but a transplanted kidney is not usually placed there due to the complexity of vascular anastomoses and limited access [1]. - Positioning in the lumbar region would require more extensive surgical dissection and potentially longer vascular connections. *Epigastrium* - The epigastrium is the upper central part of the abdomen, above the navel. - This location is not suitable for kidney transplantation due to anatomical constraints and the lack of readily accessible large blood vessels for connection. *Beside the dysfunctional Kidney* - The dysfunctional native kidneys are usually left in place unless they are causing severe complications like uncontrolled hypertension or infection. - Placing the transplanted kidney directly beside the native dysfunctional kidney is not the standard procedure due to space limitations and to avoid operating near potentially diseased native organs.

Q: Claudication due to femoropopliteal incompetence is primarily seen in

Calf. ***Calf*** - **Femoropopliteal incompetence** refers to insufficiency in the superficial femoral and popliteal arteries. Blockage in these arteries typically results in **claudication** symptoms downstream from the obstruction. - The **calf muscles** receive their blood supply via these arteries and are therefore the primary site of pain due to inadequate blood flow during exertion, manifesting as claudication. *Thigh* - Claudication in the **thigh** is usually associated with more proximal arterial obstructions in the **aortoiliac system** or common femoral artery. - While thigh muscles are located upstream from the calf, pain would indicate a blockage higher up than the femoropopliteal segment. *Buttocks* - **Buttock claudication** points to very proximal arterial disease, specifically involving the **internal iliac arteries** or the distal aorta (**Leriche syndrome**). - This is even further upstream than the femoropopliteal arteries and would involve more significant and widespread circulatory compromise. *Feet* - While the **feet** can experience pain due to arterial insufficiency, particularly with severe disease or at rest, isolated foot claudication is less common. - **Claudication** specifically points to muscle ischemia during activity, and the robust musculature of the calf makes it the primary site when femoropopliteal arteries are involved.

Q: Which of the following is the correct management of abdominal compartment syndrome?

Urgent decompressive laparotomy. ***Urgent decompressive laparotomy*** - The definitive treatment for abdominal compartment syndrome (ACS) is **urgent surgical decompression** via **decompressive laparotomy**. - This involves opening the abdominal fascia to immediately **reduce intra-abdominal pressure (IAP)**, typically indicated when IAP >20 mmHg with new organ dysfunction. - Decompression is crucial to prevent irreversible organ damage, restore perfusion to compressed organs, and improve ventilation. - The abdomen is often left open temporarily with negative pressure wound therapy until the patient stabilizes. *Antihypertensives* - Antihypertensives may manage systemic hypertension but do not address the **elevated intra-abdominal pressure** that is the primary pathology in ACS. - This approach is insufficient and could worsen **organ perfusion** by reducing the perfusion pressure gradient (MAP - IAP) to already compressed abdominal organs. - ACS requires mechanical decompression, not pharmacological blood pressure management. *Urgent Fasciotomy* - Fasciotomy is the correct treatment for **extremity compartment syndrome** (e.g., leg, forearm), where it relieves pressure within muscle compartments. - It is anatomically inappropriate for **abdominal compartment syndrome**, which requires opening the abdominal cavity, not limb fascial compartments. - This represents a fundamental misunderstanding of the anatomical site requiring decompression. *Wait and monitor for 24 hours* - ACS is a **surgical emergency** that can rapidly progress to multiorgan failure, acute kidney injury, respiratory failure, and cardiovascular collapse. - Delaying intervention by 24 hours would likely result in **irreversible organ damage** and significantly increased mortality. - Once diagnosed (IAP >20 mmHg with organ dysfunction), urgent decompression is mandatory.

Q: An Incisional wound heals by

Primary Healing. ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.

Question 1

Food can commonly get obstructed in the esophagus at all of the following locations except

Accepted Answer

Crossing of the hemiazygous vein

Answer

Crossing of left bronchus

Answer

Crossing of arch of aorta

Answer

Diaphragmatic aperture

Question 2

Which of the following statements about MALToma is true?

Accepted Answer

H. Pylori infection is a known risk factor

Answer

They are primary gastric lymphomas

Answer

They are a type of T cell lymphoma

Answer

Exclusively seen in the gastric antrum

Question 3

In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?

Accepted Answer

Cholesterolosis of the gallbladder

Answer

Gangrene of the gallbladder

Answer

Porcelain gallbladder

Answer

Adenomatosis of the gallbladder

Question 4

Which of the following is NOT a recognized cause of Urothelial Carcinomas?

Accepted Answer

Alcohol consumption

Answer

Industrial solvents

Answer

Exposure to thorotrast

Answer

Smoking

Question 5

What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?

Accepted Answer

CT scan

Answer

Angiography

Answer

Colour doppler imaging

Answer

IVP

Question 6

Reactionary Hemorrhage occurs due to?

Accepted Answer

Dislodgement of clot

Answer

Infection

Answer

Damage to a blood vessel

Answer

Pressure necrosis

Question 7

Transplanted kidney is relocated to which region in the recipient's body?

Accepted Answer

Retroperitoneal region

Answer

Lumbar region

Answer

Epigastrium

Answer

Beside the dysfunctional kidney

Question 8

Claudication due to femoropopliteal incompetence is primarily seen in

Accepted Answer

Calf

Answer

Thigh

Answer

Buttocks

Answer

Feet

Question 9

Which of the following is the correct management of abdominal compartment syndrome?

Accepted Answer

Urgent decompressive laparotomy

Answer

Antihypertensives

Answer

Urgent Fasciotomy

Answer

Wait and monitor for 24 hours

Question 10

An Incisional wound heals by

Accepted Answer

Primary Healing

Answer

Secondary Healing

Answer

Epithelialization

Answer

Delayed primary Healing

NEET-PG 2015

Anatomy

Pathology

Radiology

Surgery