Internal Medicine
1 questionsAll of the following may lead to gall bladder carcinoma except which of the following?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1161: All of the following may lead to gall bladder carcinoma except which of the following?
- A. Gall Bladder Polyps
- B. Typhoid carriers
- C. Echinococcus Granulosus Infection (Correct Answer)
- D. Exposure to carcinogens like nitrosamine
Explanation: ***Echinococcus Granulosus Infection*** - Echinococcus granulosus is primarily associated with **hydatid cyst formation**, not directly linked to gallbladder carcinoma. - This infection typically affects the **liver** rather than inducing malignant transformation in the gallbladder. *Typhoid carriers* - Chronic infection with **Salmonella typhi** in carriers can cause **gallbladder inflammation** and is a risk factor for gallbladder cancer. - Typhoid carriers retain the bacteria in the gallbladder, leading to chronic irritation and potentially malignant changes. *Gall Bladder Polyps* - Certain types of gallbladder polyps, especially those larger than **1 cm**, have a significant risk of undergoing malignant transformation. - They are associated with **chronic inflammation** and may progress to cancer if not monitored. *Exposure to carcinogens like nitrosamine* - Nitrosamines are known **carcinogens** that can induce protein modifications leading to DNA damage, contributing to gallbladder cancer. - Long-term exposure to such chemicals can result in **cellular mutations** in the gallbladder epithelial lining.
Pharmacology
1 questionsA patient undergoing a minor surgical procedure is given lignocaine injection. Assertion: Local anaesthetics act by blocking nerve conduction. Reason: Small fibers and non-myelinated fibers are blocked more easily than large myelinated fibers.
NEET-PG 2015 - Pharmacology NEET-PG Practice Questions and MCQs
Question 1161: A patient undergoing a minor surgical procedure is given lignocaine injection. Assertion: Local anaesthetics act by blocking nerve conduction. Reason: Small fibers and non-myelinated fibers are blocked more easily than large myelinated fibers.
- A. Assertion is false, but Reason is true
- B. Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion (Correct Answer)
- C. Both Assertion and Reason are true, and Reason is the correct explanation for Assertion
- D. Assertion is true, but Reason is false
Explanation: ***Both Assertion and Reason are true, and Reason is NOT the correct explanation for Assertion*** - The **Assertion** is true: Local anesthetics (like lignocaine) block nerve conduction by inhibiting **voltage-gated sodium channels**, preventing the depolarization necessary for action potential propagation - The **Reason** is also true: Small diameter and non-myelinated fibers (like C and Aδ pain fibers) are blocked more easily than large myelinated fibers (like Aα motor fibers), which explains the **differential blockade** pattern seen clinically - However, the **Reason does NOT explain WHY** local anesthetics block nerve conduction—it describes **WHICH** nerve fibers are blocked preferentially. The mechanism of blocking conduction is sodium channel inhibition, not fiber size selectivity - The differential sensitivity is a consequence of fiber characteristics (surface area-to-volume ratio, number of nodes of Ranvier), not the explanation for the blocking mechanism itself *Both Assertion and Reason are true, and Reason is the correct explanation for Assertion* - While both statements are individually true, the Reason does not explain the **mechanism** by which local anesthetics block nerve conduction - The Reason addresses fiber **selectivity**, which is a separate pharmacological property from the **mechanism of action** (sodium channel blockade) *Assertion is true, but Reason is false* - The Assertion is demonstrably true—local anesthetics block nerve conduction - The Reason is also true—this is well-established pharmacology: autonomic (small) > sensory (medium) > motor (large) fiber blockade sequence *Assertion is false, but Reason is true* - The Assertion is fundamentally correct and represents the primary pharmacological action of local anesthetics - Blocking nerve conduction is the therapeutic goal of local anesthetic administration
Surgery
8 questionsA 35 year old male came with jaundice, palpable mass in the right hypochondrium not associated with pain. The probable diagnosis is -
A 60-year-old male presented with jaundice, pale stools, dark urine, and a mass in the epigastric region. Which of the following diagnoses is least likely to be the cause of these symptoms?
Which of the following statements about Gallbladder carcinoma is true?
Which of the following stoma is formed in Hartmann's procedure?
Most common site of colorectal carcinoma?
Which of the following characteristics is most accurate about Boerhaave syndrome?
Which of the following is true about Mallory-Weiss tear -
A 55 year old woman presented with history of recurrent episodes of right upper abdominal pain for the last one year. She presented to emergency with history of jaundice and fever for 2 days. On examination, the patient appeared toxic and had a blood pressure of 100/60 mmHg. She was started on intravenous antibiotics. Ultrasound of the abdomen showed presence of stones in the common bile duct. What would be the best treatment option for her -
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1161: A 35 year old male came with jaundice, palpable mass in the right hypochondrium not associated with pain. The probable diagnosis is -
- A. Hepatocellular carcinoma
- B. Choledochal cyst
- C. Acute cholecystitis
- D. Pancreatic head carcinoma (Correct Answer)
Explanation: ***Pancreatic head carcinoma*** - **Pancreatic head carcinoma** classically presents with **painless progressive jaundice**, which is the hallmark feature of malignant biliary obstruction. - The **palpable mass in the right hypochondrium** represents a **palpable, non-tender gallbladder** known as **Courvoisier's sign** - indicating distal common bile duct obstruction with gallbladder distension. - **Courvoisier's law** states: "A palpable gallbladder in the presence of jaundice is unlikely to be due to stones and suggests malignant obstruction of the biliary tree." - The **absence of pain** is characteristic, as the obstruction develops gradually, unlike acute inflammatory conditions. *Hepatocellular carcinoma* - **Hepatocellular carcinoma (HCC)** can present with a palpable hepatic mass and hepatomegaly in the right hypochondrium. - However, jaundice in HCC is typically a **late feature** occurring with massive liver involvement, extensive hepatic replacement by tumor, or portal vein thrombosis - not early painless jaundice. - HCC more commonly presents with abdominal pain, weight loss, and symptoms of chronic liver disease rather than painless obstructive jaundice. *Acute cholecystitis* - **Acute cholecystitis** presents with severe **right upper quadrant pain** (Murphy's sign positive), fever, and leukocytosis. - The **absence of pain** in this patient makes acute cholecystitis very unlikely. - While a tender palpable gallbladder may be present, painless presentation is not characteristic. *Choledochal cyst* - **Choledochal cysts** can present with the classic triad of **jaundice, abdominal pain, and palpable mass**. - However, they are **more common in children and young females** (80% present before age 10). - The presentation usually includes **episodic abdominal pain** due to recurrent cholangitis or pancreatitis, making the painless presentation less typical. - In a 35-year-old male with painless jaundice, pancreatic malignancy is more likely.
Question 1162: A 60-year-old male presented with jaundice, pale stools, dark urine, and a mass in the epigastric region. Which of the following diagnoses is least likely to be the cause of these symptoms?
- A. Biliary Cancer
- B. Periampullary Cancer
- C. Pancreatic Cancer
- D. Chronic Cholecystitis (Correct Answer)
Explanation: ***Chronic Cholecystitis*** - While chronic cholecystitis can cause epigastric pain, it rarely presents with **jaundice**, **pale stools**, and **dark urine** because it typically does not obstruct the common bile duct. - The presence of a palpable **epigastric mass** is also not a common feature of chronic cholecystitis. *Biliary Cancer* - **Biliary cancer**, particularly choledochal cancer, can cause **obstructive jaundice**, leading to **pale stools** (lack of bilirubin) and **dark urine** (conjugated bilirubin in urine). - A mass in the **epigastric region** could represent an enlarged gallbladder due to distal obstruction (Courvoisier's sign) or the tumor itself. *Periampullary Cancer* - **Periampullary cancers**, which arise near the ampulla of Vater, characteristically cause **obstructive jaundice**, presenting with **pale stools** and **dark urine**. - A mass in the **epigastric region** might be the tumor or a dilated gallbladder due to bile duct obstruction. *Pancreatic cancer* - **Pancreatic head cancer** frequently obstructs the common bile duct, resulting in **jaundice**, **pale stools**, and **dark urine**. - An **epigastric mass** can be the palpable tumor itself or an enlarged, distended gallbladder.
Question 1163: Which of the following statements about Gallbladder carcinoma is true?
- A. Carries a good prognosis
- B. Gallstones may be a predisposing factor (Correct Answer)
- C. Commonly squamous cell carcinoma
- D. Jaundice is rare
Explanation: ***Gallstones may be a predisposing factor*** - The chronic inflammation and irritation caused by **gallstones (cholelithiasis)** are considered major risk factors for the development of gallbladder carcinoma. - Approximately 70-90% of patients with gallbladder carcinoma also have **cholelithiasis**, suggesting a strong association. *Carries a good prognosis* - Gallbladder carcinoma generally has a **poor prognosis** due to its asymptomatic nature in early stages and aggressive local invasion. - Most cases are diagnosed at an advanced stage, leading to a **low 5-year survival rate**. *Commonly squamous cell carcinoma* - The vast majority of gallbladder carcinomas are **adenocarcinomas** (around 90%), arising from the glandular epithelium. - **Squamous cell carcinoma** is rare, accounting for only a small percentage of cases. *Jaundice is rare* - **Jaundice** is a common symptom in advanced gallbladder carcinoma, often indicating obstruction of the biliary ducts. - It arises when the tumor invades or compresses the **common bile duct**, leading to bilirubin backup.
Question 1164: Which of the following stoma is formed in Hartmann's procedure?
- A. End Colostomy (Correct Answer)
- B. End Ileostomy
- C. Loop Ileostomy
- D. Caecostomy
Explanation: ***End Colostomy*** - Hartmann's procedure involves resection of a diseased segment of the **colon**, typically the sigmoid colon, with the creation of a **proximal colostomy** and closure of the distal rectal stump. - The proximal end of the colon is brought out through the abdominal wall to form a **stoma**, which is a type of end colostomy. *End Ileostomy* - An end ileostomy involves bringing the **ileum** (small intestine) to the abdominal wall, which is not part of the standard Hartmann's procedure. - This is typically performed after a **total colectomy** or in cases of severe Crohn's disease affecting the colon. *Loop Ileostomy* - A loop ileostomy involves bringing a **loop of the ileum** to the surface of the abdomen, creating two openings that are then joined together. - This is often a **temporary diversion** and does not involve resection of the colon in the same manner as Hartmann's procedure. *Caecostomy* - A caecostomy is a stoma created from the **cecum**, the beginning of the large intestine. - This is typically performed for various reasons such as **bowel decompression** or management of fecal incontinence, and is not a component of Hartmann's procedure.
Question 1165: Most common site of colorectal carcinoma?
- A. Ascending Colon
- B. Descending Colon
- C. Rectum
- D. Sigmoid Colon (Correct Answer)
Explanation: ***Sigmoid Colon*** - The **sigmoid colon** is the most common site for colorectal carcinoma, accounting for approximately **25%** of all cases. - This higher incidence is potentially due to its role in stool storage, leading to longer contact time with potential carcinogens. *Rectum* - While the rectum is a common site, it accounts for about **15-20%** of colorectal cancers, making it less frequent than the sigmoid colon. - Rectal cancers often present with **hematochezia** and changes in bowel habits. *Ascending Colon* - The **ascending colon** is less frequently affected, around **10-15%** of cases. - Tumors here are often associated with **iron deficiency anemia** due to chronic blood loss. *Descending Colon* - The **descending colon** is also less commonly affected, making up approximately **5-10%** of colorectal cancers. - Tumors in this segment may present with **obstruction** due to the narrower lumen.
Question 1166: Which of the following characteristics is most accurate about Boerhaave syndrome?
- A. Most cases follow a bout of heavy eating or drinking
- B. Perforation of the esophagus due to barotrauma (Correct Answer)
- C. Sudden severe chest pain is an early manifestation
- D. Most common site is left posterolateral aspect 3 - 5 cms above the gastroesophageal junction
Explanation: ***Perforation of the esophagus due to barotrauma*** - **Boerhaave syndrome** is a spontaneous esophageal rupture caused by a sudden increase in **intraesophageal pressure** against a closed glottis, leading to barotrauma. - This typically occurs during forceful **vomiting** or **retching**, expelling gastric contents through the weakened esophageal wall. *Sudden severe chest pain is an early manifestation* - While **sudden, severe chest pain** is a hallmark symptom, it is a manifestation of the syndrome rather than its defining characteristic or cause. - The chest pain is a direct result of the esophageal tear and the leakage of gastric contents into the mediastinum, causing irritation and inflammation. *Most cases follow a bout of heavy eating or drinking* - **Heavy eating or drinking** (especially alcohol) can precipitate vomiting, which is the direct cause of the rupture, but it is not the syndrome's most accurate characteristic. - The actual mechanism is the severe increase in transesophageal pressure during forceful emesis, not simply the consumption itself. *Most common site is left posteromedial aspect 3 - 5 cms above the gastroesophageal junction* - This statement accurately pinpoints the **most common anatomical location** of the esophageal tear in Boerhaave syndrome due to the inherent weakness at this site. - However, it describes the **localization** of the injury rather than the fundamental characteristic of the syndrome, which is the perforation itself due to barotrauma.
Question 1167: Which of the following is true about Mallory-Weiss tear -
- A. It is a mucosal tear not extending through the muscle layer (Correct Answer)
- B. It is more common in women than men
- C. It is common in young individuals
- D. It is associated with achalasia cardia
Explanation: ***It is a mucosal tear not extending through the muscle layer*** - A **Mallory-Weiss tear** is defined as a longitudinal tear in the **mucosa** of the distal esophagus or proximal stomach. - These tears typically do not extend through the **muscularis propria** layer, distinguishing them from a Boerhaave syndrome, which is a full-thickness rupture. *It is more common in women than men* - Mallory-Weiss tears show a **male predominance** with a male-to-female ratio of approximately 2-4:1. - Risk factors like **alcohol use disorder** and forceful vomiting are more common in males, contributing to this gender distribution. *It is common in young individuals* - Mallory-Weiss tears are more common in **middle-aged to older individuals**, typically between 40 and 60 years old. - The condition is rare in young children or teenagers. *It is associated with achalasia cardia* - While both conditions affect the esophagus, there is **no direct causal association** between Mallory-Weiss tears and **achalasia cardia**. - Achalasia is a motility disorder, whereas Mallory-Weiss tears are caused by sudden increases in intra-abdominal pressure.
Question 1168: A 55 year old woman presented with history of recurrent episodes of right upper abdominal pain for the last one year. She presented to emergency with history of jaundice and fever for 2 days. On examination, the patient appeared toxic and had a blood pressure of 100/60 mmHg. She was started on intravenous antibiotics. Ultrasound of the abdomen showed presence of stones in the common bile duct. What would be the best treatment option for her -
- A. Open bile duct surgery for stone removal
- B. Lithotripsy for bile duct stones
- C. Laparoscopic cholecystectomy (gallbladder removal)
- D. Endoscopic Retrograde Cholangiopancreatography (ERCP) and bile duct stone extraction (Correct Answer)
Explanation: ***Endoscopic Retrograde Cholangiopancreatography (ERCP) and bile duct stone extraction*** - The patient presents with **Reynolds' pentad** (Charcot's triad - right upper abdominal pain, jaundice, fever - plus hypotension and toxic appearance/altered mental status), indicating severe acute **cholangitis with septic shock** due to common bile duct stones. - **ERCP with stone extraction** is the most appropriate initial treatment in this unstable patient to achieve rapid biliary decompression and remove the obstruction, which is life-saving in septic cholangitis. - This minimally invasive approach provides urgent drainage while minimizing surgical stress in a critically ill patient. *Laparoscopic cholecystectomy (gallbladder removal)* - While cholecystectomy addresses gallbladder stones, it does not directly remove **common bile duct stones** causing the current acute cholangitis. - Performing cholecystectomy alone in an acutely septic patient would not resolve the immediate life-threatening biliary obstruction. - Cholecystectomy can be considered later (interval cholecystectomy) after stabilization and ERCP. *Open bile duct surgery for stone removal* - This is a more invasive procedure with higher morbidity and mortality compared to ERCP for initial management of common bile duct stones, especially in an acutely ill, hemodynamically unstable patient. - **Open surgery** is typically reserved for cases where ERCP fails or is not feasible, or for complex cases requiring biliary reconstruction. *Lithotripsy for bile duct stones* - **Lithotripsy** (fragmenting stones) is not appropriate for initial management of acute cholangitis with sepsis, as it does not provide immediate biliary drainage. - It might be considered as an adjunct for very large or impacted stones during ERCP, but it's not the primary immediate treatment in this emergency setting.