NEET-PG 2015 Practice Questions

Q: Bilateral parotid enlargement occurs in all, Except:

Chronic pancreatitis. ***SLE*** - **Systemic Lupus Erythematosus (SLE)** typically does not present with **bilateral parotid enlargement**, which is more characteristic of other conditions. - Salivary gland involvement in SLE is less prevalent and usually not the primary clinical feature associated with the disease. *HIV* - **HIV** infection can lead to **bilateral parotid enlargement** due to associated conditions such as lymphadenopathy and infections like **salivary gland infections**. [1] - **Lymphoid tissue** hyperplasia in response to HIV is another factor contributing to this enlargement. *Sjogren's syndrome* - **Sjogren's syndrome** is a common cause of **bilateral parotid enlargement** due to inflammatory infiltrates affecting the salivary glands. - Patients typically experience **xerostomia** (dry mouth) and **xerophthalmia** (dry eyes) alongside gland enlargement [2]. *Chronic pancreatitis* - Patients with **chronic pancreatitis** may develop **bilateral parotid enlargement** due to associated changes such as **sialadenosis** from malnutrition and electrolyte imbalances. - The enlargement occurs as a **compensatory mechanism** related to the pancreatic pathology affecting nearby structures.

Q: Which of the following is NOT a common complication of acute pancreatitis?

Hypercalcemia. ***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].

Q: Chronic hemolytic anaemia is associated with which of the following -

Black Pigment stone of the gall bladder. ***Black Pigment stone of the gall bladder*** - Chronic hemolytic anemia leads to increased **bilirubin**, particularly unconjugated bilirubin, which can result in the formation of **black pigment stones** [1]. - These stones are associated with conditions causing **excess bilirubin production**, such as sickle cell disease and thalassemia. *Brown Pigment stone of the gall bladder* - Brown pigment stones are primarily associated with **infection** and **biliary tract disorders**, not directly with chronic hemolytic anemia. - They are mainly composed of **calcium bilirubinate**, which arises in cases of **bacterial infections** or parasitic infestations. *Intestinal Obstruction* - While hemolytic anemia can have various complications, it is **not directly linked with intestinal obstruction**. - Obstruction typically arises from **mechanical causes** such as adhesions, tumors, or hernias, rather than from hemolytic processes. *Uric acid Renal Calculus* - Uric acid stones are formed due to conditions leading to **hyperuricemia** and are not a primary consequence of chronic hemolytic anemia. - They are often associated with **gout** and **certain metabolic disorders**, rather than hemolytic processes.

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: All of the following are surgical options in the management of esophageal carcinoma except -

Sistrunk operation. ***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.

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

Question 1

Bilateral parotid enlargement occurs in all, Except:

Accepted Answer

Chronic pancreatitis

Answer

HIV

Answer

SLE

Answer

Mumps

Question 2

Which of the following is NOT a common complication of acute pancreatitis?

Accepted Answer

Hypercalcemia

Answer

Subcutaneous fat necrosis

Answer

Hyperlipidemia

Answer

Increased amylase level

Question 3

Chronic hemolytic anaemia is associated with which of the following -

Accepted Answer

Black Pigment stone of the gall bladder

Answer

Brown Pigment stone of the gall bladder

Answer

Uric acid Renal Calculus

Answer

Intestinal Obstruction

Question 4

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 5

All of the following are surgical options in the management of esophageal carcinoma except -

Accepted Answer

Sistrunk operation

Answer

Ivor Lewis Approach

Answer

McKeown's Approach

Answer

Transhiatal removal

Question 6

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 7

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 8

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 9

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 10

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

NEET-PG 2015

General Medicine

Internal Medicine

Surgery