Dental
1 questionsIn which of the following causes of oral ulcers are auto-antibodies not seen?
NEET-PG 2015 - Dental NEET-PG Practice Questions and MCQs
Question 1211: In which of the following causes of oral ulcers are auto-antibodies not seen?
- A. Behcet disease (Correct Answer)
- B. SLE
- C. Pemphigus
- D. Celiac disease
Explanation: ***Behcet disease*** - Behcet disease is characterized by **recurrent oral and genital ulcers**, along with **eye lesions**, but it does not involve autoantibody formation. - The underlying mechanism is believed to be **immune dysregulation** rather than autoimmunity, making it distinctive. *Celiac disease* - In Celiac disease, **anti-tissue transglutaminase** antibodies are present, which are involved in the body's response to gluten. - Oral ulcers associated with Celiac are often related to nutrient deficiencies, particularly **iron and folate**. *SLE* - Systemic lupus erythematosus (SLE) is marked by various autoantibodies, including **antinuclear antibodies (ANA)** [1]. - Oral ulcers can occur in SLE, and these are a manifestation of its **autoimmune nature** [1]. *Pemphigus* - Pemphigus is characterized by the presence of **autoantibodies** against desmogleins, leading to **blistering** and ulcer formation. - Oral ulcers are common in this condition due to the **disruption of mucosal integrity** caused by the autoimmune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 226.
Internal Medicine
3 questionsWhich of the following conditions is least likely to cause multiple painful ulcers on the tongue?
A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1211: Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?
- A. TB
- B. Herpes
- C. Behcet disease
- D. Sarcoidosis (Correct Answer)
Explanation: ***Sarcoidosis*** - While sarcoidosis can affect any organ, **oral involvement is rare** and typically presents as **nodules, plaques, or generalized swelling**, not usually multiple painful ulcers on the tongue. - The lesions, when they occur, are often **painless** and appear as submucosal nodules, red patches, or diffuse swelling. *TB* - Oral tuberculosis can present as **multiple painful ulcers** on the tongue, often with a **granulomatous appearance** mimicking squamous cell carcinoma. - These ulcers are typically **irregular, undermined, and persistent**, often associated with pulmonary TB. *Herpes* - **Herpes simplex virus (HSV)** infection, particularly primary herpetic gingivostomatitis, commonly causes **multiple painful ulcers** on the tongue, gums, and other oral mucosa. - These ulcers begin as vesicles that **rupture to form painful erosions** and are a classic presentation of oral herpes. *Behcet disease* - **Oral aphthous ulcers** are a hallmark feature of Behcet disease, commonly presenting as **multiple, recurrent, painful ulcers** on the tongue and other oral mucosal surfaces. - These ulcers are clinically indistinguishable from common aphthous stomatitis but are more frequent and often associated with genital ulcers, skin lesions, and ocular inflammation.
Question 1212: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
- A. Serum GGT (Correct Answer)
- B. Serum LDH
- C. Base deficit
- D. Age
Explanation: ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.
Question 1213: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:
- A. Splenic Vein Thrombosis (Correct Answer)
- B. Bleeding
- C. Gastric Outlet Obstruction
- D. Perforation
Explanation: ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.
Pathology
2 questionsWhat is the number of Barr bodies present in Klinefelter's syndrome?
Which of the following testicular tumours is NOT a germ cell tumour?
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 1211: What is the number of Barr bodies present in Klinefelter's syndrome?
- A. 0
- B. 1 (Correct Answer)
- C. 2
- D. 3
Explanation: ***1*** - **Klinefelter's syndrome** typically has a 47,XXY karyotype, meaning there are two X chromosomes [1]. - The number of Barr bodies is calculated as **N-1**, where N is the total number of X chromosomes. In this case, 2-1 = **1 Barr body** [1]. - This follows the principle that one X chromosome remains active while additional X chromosomes are inactivated [1]. *0* - **No Barr bodies** are found in individuals with a normal male karyotype (46,XY) or in Turner syndrome (45,XO), neither of which describes Klinefelter's syndrome [1]. - The presence of at least one Barr body indicates the presence of at least two X chromosomes. *2* - **Two Barr bodies** would be indicative of a karyotype with three X chromosomes (e.g., 47,XXX syndrome or Triple X syndrome), which is not Klinefelter's syndrome. - This calculation follows the N-1 rule: 3 X chromosomes - 1 = 2 Barr bodies. *3* - **Three Barr bodies** would correspond to a karyotype with four X chromosomes (e.g., 48,XXXX), which is an even rarer sex chromosome aneuploidy not associated with Klinefelter's syndrome. - The N-1 rule applies: 4 X chromosomes - 1 = 3 Barr bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-174.
Question 1212: Which of the following testicular tumours is NOT a germ cell tumour?
- A. Seminoma
- B. Teratoma
- C. Choriocarcinoma
- D. Sertoli cell tumour (Correct Answer)
Explanation: ***Sertoli cell tumour*** - This is a **sex-cord stromal tumour**, not a germ cell tumour, hence it does not arise from germ cells. - Sertoli cell tumours typically present with abnormal hormone levels, but not the classic germ cell tumour markers. *Choriocarcinoma* - This is a **germ cell tumour** that is aggressive and associated with high levels of **beta-hCG** [1][2]. - It derives from the placental tissue and is characterized by **trophoblastic differentiation** [2]. *Seminoma* - A well-known type of **germ cell tumour**, often presenting as a **homogeneous testicular mass** [1]. - It usually manifests with elevated **LDH** and is associated with a more favorable prognosis compared to non-seminomatous germ cell tumours [1]. *Teratoma* - Teratomas are also classified as **germ cell tumours**, containing differentiated tissues like hair, muscle, and bone [1][2]. - They can be **mature** (benign) or **immature** (malignant), and are typically found in younger patients [2][3]. **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. 979-980. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 982-983. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.
Surgery
4 questionsWhat is the best management for a human bite?
RPLND and Chemotherapy may be used in management of?
The Grayhack shunt is established between which of the following?
Which of the following statements about undescended testis is true?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1211: What is the best management for a human bite?
- A. Ampicillin plus sulbactam (Correct Answer)
- B. Clindamycin plus TMP-SMX
- C. Fluoroquinolone
- D. Doxycycline
Explanation: ***Ampicillin plus sulbactam*** - This combination is effective against the common **aerobic and anaerobic bacteria** found in human bite wounds, including **Eikenella corrodens** and oral streptococci. - The sulbactam component provides **beta-lactamase inhibition**, which is crucial as many oral bacteria produce these enzymes, rendering ampicillin alone ineffective. *Clindamycin plus TMP-SMX* - While clindamycin covers many anaerobes, it has **poor activity against Eikenella corrodens**, a key pathogen in human bites. - **TMP-SMX (trimethoprim-sulfamethoxazole)** also lacks reliable coverage against many oral anaerobes and Eikenella. *Fluoroquinolone* - **Fluoroquinolones** generally have good Gram-negative coverage but often possess **limited activity against oral anaerobes and streptococci** relevant to human bites. - There is a **growing concern for resistance** with fluoroquinolone monotherapy in these types of infections. *Doxycycline* - Doxycycline has a broad spectrum but is **not the first-line choice for human bites** due to inconsistent activity against common oral anaerobes and Eikenella corrodens. - It may be considered in specific cases, but **empiric coverage needs to be broader** for initial management of these **polymicrobial infections**.
Question 1212: RPLND and Chemotherapy may be used in management of?
- A. Non-seminomatous germ cell tumors of the testis (Correct Answer)
- B. Non-germ cell tumors
- C. Seminomatous germ cell tumors
- D. Lymphoma of the testis
Explanation: ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.
Question 1213: The Grayhack shunt is established between which of the following?
- A. Corpora cavernosa and dorsal vein
- B. Corpora cavernosa and saphenous vein (Correct Answer)
- C. Corpora cavernosa and glans
- D. Corpora cavernosa and corpora spongiosa
Explanation: ***Corpora cavernosa and saphenous vein*** - The **Grayhack shunt** is a type of **cavernosal-venous shunt**, specifically connecting the corpus cavernosum to the saphenous vein. - This procedure is typically performed to surgically manage **priapism** by diverting blood from the trapped penile cavernosal spaces. *Corpora cavernosa and dorsal vein* - While other **cavernosal-venous shunts** can be created between the corpora cavernosa and the dorsal vein (e.g., Al-Ghorab shunt), the Grayhack shunt specifically involves the **saphenous vein**. - The dorsal vein approach is usually considered for more distal shunts. *Corpora cavernosa and glans* - This describes a **distal cavernosal-glanular shunt** (e.g., Winter or Ebbehoj), which involves creating a communication between the corpus cavernosum and the glans penis to relieve priapism. - The Grayhack shunt is a more **proximal** and **cavernosal-venous** type of shunt. *Corpora cavernosa and corpora spongiosa* - This describes a **cavernosal-spongiosal shunt**, such as the Quackels shunt, where connection is made between the corpora cavernosa and the corpus spongiosum. - This type of shunt is also used for priapism but is distinct from the cavernosal-venous Grayhack shunt.
Question 1214: Which of the following statements about undescended testis is true?
- A. Hormonal therapy is effective
- B. More common on the right side
- C. Increased risk of malignancy (Correct Answer)
- D. Secondary sexual characteristics are universally normal
Explanation: ***Increased risk of malignancy*** - Undescended testis is associated with a **3 to 14 times increased risk** of testicular malignancy, particularly **seminoma**. - The risk remains elevated even after orchiopexy, though the procedure allows for **easier surveillance and examination**. - This is one of the **most important clinical features** of cryptorchidism and a key reason for early surgical correction. - Even a **corrected cryptorchid testis** maintains higher cancer risk compared to normally descended testes. *Secondary sexual characteristics are universally normal* - In **unilateral cryptorchidism** (90% of cases), the normally descended contralateral testis produces **adequate testosterone** for normal secondary sexual development. - However, in **bilateral cryptorchidism** or if the descended testis is functionally impaired, **testosterone deficiency** can occur, leading to delayed or abnormal sexual development. - Therefore, secondary sexual characteristics are **not universally normal** in all cases of undescended testis. *Hormonal therapy is effective* - Hormonal therapy with **hCG (human chorionic gonadotropin)** or **GnRH (gonadotropin-releasing hormone)** has **limited and inconsistent effectiveness**. - Success rates are generally **low** (10-30%), particularly for truly undescended testes (as opposed to retractile testes). - **Orchiopexy** (surgical correction) remains the **definitive treatment**, ideally performed between **6-18 months of age** to optimize fertility potential. *More common on the right side* - Undescended testis is actually **slightly more common on the left side** (~55-60%) than the right (~40-45%). - **Bilateral cryptorchidism** occurs in approximately 10-20% of cases. - There is no significant right-sided predilection.