Internal Medicine
1 questionsThyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1161: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be
- A. Follicular adenoma (Correct Answer)
- B. Multinodular goiter
- C. Thyroid cyst
- D. Follicular carcinoma
Explanation: ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.
Obstetrics and Gynecology
1 questionsWhich of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1161: Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
- A. Cervical intraepithelial Neoplasia (Correct Answer)
- B. Ductal carcinoma in situ of breast
- C. Lobular carcinoma in situ of breast
- D. Vaginal intraepithelial neoplasia
Explanation: ***Cervical intraepithelial neoplasia (CIN)*** - CIN has a high success rate with treatment (e.g., **cryotherapy**, **LEEP**), often completely eradicating the dysplastic cells and preventing progression to **invasive cervical cancer**. - The effectiveness of screening via **Pap smears** allows for early detection and intervention, significantly reducing cancer risk. *Ductal carcinoma in situ (DCIS) of breast* - While treatable, DCIS carries a higher risk of recurrence and progression to **invasive breast cancer** in the same or contralateral breast compared to CIN. - Treatment often involves **lumpectomy** with or without radiation, and sometimes **total mastectomy**, reflecting its more serious potential. *Lobular carcinoma in situ (LCIS) of breast* - LCIS is largely considered a **risk indicator** for future invasive cancer in either breast, rather than a direct precursor that inevitably progresses. - Management often involves **close surveillance** or **chemoprevention**, as surgical excision does not prevent cancer development in other areas of the breast. *Vaginal intraepithelial neoplasia (VAIN)* - While treatable, VAIN is less common and often coexists with or follows **cervical or vulvar neoplasia**, indicating a broader field defect due to **HPV**. - Recurrence rates post-treatment can be significant, and patients often require long-term follow-up due to the continued risk of progression.
Pathology
3 questionsWhich of the following statements about MALToma is true?
In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?
Which of the following is NOT a recognized cause of Urothelial Carcinomas?
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 1161: Which of the following statements about MALToma is true?
- A. They are primary gastric lymphomas
- B. H. Pylori infection is a known risk factor (Correct Answer)
- C. They are a type of T cell lymphoma
- D. Exclusively seen in the gastric antrum
Explanation: ***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.
Question 1162: In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?
- A. Gangrene of the gallbladder
- B. Porcelain gallbladder
- C. Adenomatosis of the gallbladder
- D. Cholesterolosis of the gallbladder (Correct Answer)
Explanation: ***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.
Question 1163: Which of the following is NOT a recognized cause of Urothelial Carcinomas?
- A. Industrial solvents
- B. Exposure to thorotrast
- C. Alcohol consumption (Correct Answer)
- D. Smoking
Explanation: ***Alcohol consumption*** - Research does not support a direct association between **alcohol consumption** and an increased risk of urothelial carcinomas. - While excessive alcohol can lead to other forms of cancer, it is not a recognized risk factor for **bladder cancer** specifically. *Smoking* - Smoking is a well-established risk factor for **urothelial carcinomas**, significantly increasing the risk of **bladder cancer** [1]. - It is responsible for up to **50% of bladder cancer cases**, due to carcinogens in tobacco smoke [1]. *Exposure to thorotrast* - **Thorotrast**, a radiopaque contrast medium, is associated with **radiation exposure**, which is a known risk for urothelial carcinomas [3]. - Its use has been linked to increased incidence of bladder cancer due to radioactive properties [3]. *Industrial solvents* - Exposure to various **industrial solvents** such as **aromatic amines** has been linked to a higher risk of developing urothelial carcinomas [1][2]. - These chemicals are commonly found in **dyes**, **rubber**, and other manufacturing processes [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 968-970. [2] 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. 217-218. [3] 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. 216-217.
Radiology
1 questionsWhat is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?
NEET-PG 2015 - Radiology NEET-PG Practice Questions and MCQs
Question 1161: What is the best investigation for diagnosis and staging of renal cell carcinoma with thrombus extending into the IVC?
- A. CT scan (Correct Answer)
- B. Angiography
- C. Colour doppler imaging
- D. IVP
Explanation: ***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.
Surgery
4 questionsAn Incisional wound heals by
What is the commonest site of peptic ulcer?
Which of the following statements accurately describes a subtotal thyroidectomy?
Which of the following statements about Branchial cysts is true:
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1161: An Incisional wound heals by
- A. Primary Healing (Correct Answer)
- B. Secondary Healing
- C. Epithelialization
- D. Delayed primary Healing
Explanation: ***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 1162: What is the commonest site of peptic ulcer?
- A. Second part of the duodenum
- B. Distal third of the stomach
- C. Pylorus of the stomach
- D. First part of the duodenum (Correct Answer)
Explanation: ***First part of the duodenum*** - The **duodenal bulb** (first part of the duodenum) is the most common location for peptic ulcers due to its proximity to the pylorus, where it's exposed to **acidic chyme** and susceptible to **H. pylori infection**. - The **mucosal defenses** in the duodenum are often less robust compared to the stomach, making it more vulnerable to acid-pepsin aggression. *Second part of the duodenum* - Ulcers in the **second part of the duodenum** are relatively rare compared to the first part. - This section receives bile and pancreatic secretions which help to **neutralize stomach acid**, providing greater protection. *Distal third of the stomach* - Ulcers in the **distal third of the stomach** are less common than in the first part of the duodenum. - While **gastric ulcers** do occur, they are more frequently found in the **antrum or lesser curvature** of the stomach. *Pylorus of the stomach* - Ulcers can occur in the **pylorus**, but they are not as frequent as those in the **duodenal bulb**. - Pyloric ulcers are considered a type of **gastric ulcer** and can be associated with gastric outlet obstruction.
Question 1163: Which of the following statements accurately describes a subtotal thyroidectomy?
- A. Removal of one lobe and isthmus
- B. Removal of 1 lobe with isthmus and the second lobe partially (Correct Answer)
- C. Removal of both lobes leaving behind 6-8 grams of tissue
- D. Removal of entire thyroid with cervical lymphnodes
Explanation: ***Removal of 1 lobe with isthmus and the second lobe partially*** - A **subtotal thyroidectomy** involves removing one complete thyroid lobe along with the isthmus, and partially resecting the contralateral lobe, leaving behind a small remnant of approximately **4-8 grams** on one side. - This procedure preserves parathyroid function and the recurrent laryngeal nerve while reducing thyroid tissue, commonly used for **bilateral multinodular goiter** or **Graves' disease**. - The retained remnant maintains some thyroid function and reduces the risk of permanent **hypothyroidism** and **hypoparathyroidism**. *Removal of one lobe and isthmus* - This describes a **hemithyroidectomy** or **thyroid lobectomy**, which involves complete removal of one lobe with the isthmus. - It is typically performed for **unilateral thyroid nodules**, **follicular neoplasms**, or small **well-differentiated thyroid cancers**. - It does not involve any resection of the contralateral lobe. *Removal of both lobes leaving behind 6-8 grams of tissue* - This would describe a **bilateral subtotal thyroidectomy**, where tissue is left on both sides. - While historically performed, this is **not the standard definition** of "subtotal thyroidectomy," which specifically refers to leaving remnant tissue on only one side. - Modern practice has largely replaced this with more definitive procedures. *Removal of entire thyroid with cervical lymphnodes* - This describes a **total thyroidectomy with central or lateral neck dissection**, performed for **thyroid malignancies** with lymph node involvement. - It aims to achieve complete oncological clearance and is followed by radioactive iodine therapy in differentiated thyroid cancers. - No thyroid tissue is intentionally preserved.
Question 1164: Which of the following statements about Branchial cysts is true:
- A. 50-70% are seen in lungs
- B. They are premalignant lesions
- C. Infection is uncommon in branchial cysts
- D. Most common site is lateral neck (Correct Answer)
Explanation: ***Most common site is lateral neck*** - **Branchial cleft cysts** typically present as a mass in the **lateral neck**, anterior to the sternocleidomastoid muscle. - They are congenital anomalies resulting from incomplete obliteration of the branchial clefts during embryonic development. *50-70% are seen in lungs* - This statement is incorrect; branchial cysts are **cervical anomalous masses** arising from the branchial apparatus, not primarily found in the lungs. - Lung lesions are more commonly associated with congenital pulmonary airway malformations or bronchogenic cysts, which differ in origin. *They are premalignant lesions* - Branchial cysts are generally **benign lesions** and do not typically transform into malignancy. - While rare cases of carcinoma arising within a branchial cleft cyst have been reported, they are not considered routinely premalignant. *Infection is uncommon in branchial cysts* - Conversely, infection is a **common complication** of branchial cysts, often leading to sudden enlargement, pain, and erythema. - The presence of internal fluid and epithelial lining makes them susceptible to bacterial colonization and subsequent abscess formation.