Dental
1 questionsWhich of the following statements is true regarding dentigerous cysts?
NEET-PG 2015 - Dental NEET-PG Practice Questions and MCQs
Question 1211: Which of the following statements is true regarding dentigerous cysts?
- A. It arises in relation to unerupted teeth. (Correct Answer)
- B. It commonly encroaches upon the maxillary antrum.
- C. The mandibular third molar is a common site for occurrence.
- D. Dentigerous cysts are more common in the mandible than in the maxilla.
Explanation: ***It arises in relation to unerupted teeth.*** - A **dentigerous cyst** (also known as a follicular cyst) develops from the **reduced enamel epithelium** covering the crown of an un-erupted or impacted tooth. - It is the most common developmental odontogenic cyst and is always associated with the **crown of an impacted tooth**. *It commonly encroaches upon the maxillary antrum.* - While dentigerous cysts can occur with impacted maxillary teeth (like canines), the statement that they **commonly encroach upon the maxillary antrum** is not universally true or a defining characteristic. This is more often seen with cysts of maxillary molars when they are high in the maxilla. - The most common sites are mandibular third molars and maxillary canines, and encroachment on the antrum is not a primary diagnostic feature across all cases. *The mandibular third molar is a common site for occurrence.* - This statement is **true**; the mandibular third molar is indeed the most common tooth associated with dentigerous cysts. However, the question asks for the **most true** statement which is the definition of a dentigerous cyst. - Other common sites include maxillary canines and mandibular premolars. *Dentigerous cysts are more common in the mandible than in the maxilla.* - While the **mandibular third molar** is the most frequently involved tooth, statistically, dentigerous cysts show a roughly **equal distribution** or a slight predilection for the maxilla when all affected teeth are considered (maxillary canines are also very common), making this statement less accurate than the defining characteristic. - The prevalence between the two jaws can vary depending on the study population, but it's not definitively more common in the mandible overall.
Internal Medicine
4 questionsMost common precipitant of Raynaud's phenomenon is
What is the main contraindication for performing a liver biopsy?
A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is
Which of the following is true about menetrier's disease
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1211: Most common precipitant of Raynaud's phenomenon is
- A. Exposure to cold (Correct Answer)
- B. Exposure to heat
- C. Psychosocial triggers
- D. Exertion
Explanation: ***Exposure to cold*** - **Exposure to cold temperatures**, even mild cold, is the most frequent and characteristic trigger for **vasoconstriction** in Raynaud's phenomenon. - This leads to the classic **triphasic color changes** (white, blue, red) in the digits due to restricted blood flow. *Exposure to heat* - **Exposure to heat** generally causes **vasodilation**, which would alleviate rather than precipitate the symptoms of Raynaud's phenomenon. - While sudden temperature changes can sometimes be a factor, direct heat exposure is not a primary recognized trigger. *Psychosocial triggers* - **Emotional stress** and anxiety can indeed precipitate Raynaud's episodes in some individuals, as the **sympathetic nervous system** plays a role in vasoconstriction. - However, **cold exposure** remains the most common and potent precipitating factor across the majority of cases. *Exertion* - **Physical exertion** typically leads to **vasodilation** in working muscles and increased blood flow to the skin for heat dissipation. - It is not a common or direct precipitant of the localized vasoconstrictive attacks seen in Raynaud's phenomenon.
Question 1212: What is the main contraindication for performing a liver biopsy?
- A. Severe thrombocytopenia
- B. Liver hemangioma
- C. Presence of ascites
- D. Severe coagulopathy (Correct Answer)
Explanation: ***Severe coagulopathy*** - **Severe coagulopathy** is the main contraindication for liver biopsy due to a significantly increased risk of **hemorrhage** [1]. - A **prothrombin time (PT)** or **activated partial thromboplastin time (aPTT)** significantly prolonged beyond the normal range, or an **INR > 1.5**, should be corrected before the procedure [1]. *Severe thrombocytopenia* - While **thrombocytopenia** (platelet count <50,000/µL) does increase bleeding risk, it is often correctable with a **platelet transfusion** prior to biopsy, making it a relative rather than an absolute contraindication [1]. - The risk of major bleeding is typically lower with isolated thrombocytopenia compared to severe coagulopathy. *Liver hemangioma* - The presence of a **liver hemangioma** at the biopsy site is a contraindication as biopsying it can lead to massive hemorrhage. - However, if the biopsy can be performed safely away from the hemangioma, it is not an absolute contraindication to the procedure itself. *Presence of ascites* - **Ascites** can complicate a liver biopsy by increasing the risk of **peritoneal bleeding** and difficulty in targeting the liver [1]. - However, it is often manageable by draining the ascites or using imaging guidance, making it a relative contraindication rather than an absolute one [1].
Question 1213: A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is
- A. Endoscopy
- B. Endoscopic ultrasound
- C. Manometry (Correct Answer)
- D. PET CT
Explanation: ***Manometry*** - **Esophageal manometry** measures the pressure and coordination of muscle contractions in the esophagus, which is crucial for diagnosing motility disorders like **achalasia** [1] or **esophageal spasm** [2] that can cause difficulty swallowing liquids. - The symptom of difficulty swallowing liquids but not solids (**paradoxical dysphagia**) is characteristic of a primary esophageal motility disorder rather than a structural obstruction [1]. *Endoscopy* - **Endoscopy** is primarily used to visualize the esophagus and stomach for structural abnormalities such as **strictures**, **tumors**, or **inflammation** [1]. - While it can rule out structural causes, it is less effective for diagnosing purely functional or motility disorders [1]. *Endoscopic ultrasound* - **Endoscopic ultrasound (EUS)** provides detailed imaging of the esophageal wall and surrounding structures, helping to stage cancers or identify extrinsic compression. - It is not the primary investigation for assessing **esophageal motility**. *PET CT* - **PET CT** is primarily used in oncology for **cancer staging**, recurrence detection, and assessing metabolic activity of lesions. - It has limited utility in the initial diagnosis of a **swallowing disorder**, especially one indicating a motility issue.
Question 1214: Which of the following is true about menetrier's disease
- A. Atrophied mucosal folds are seen
- B. It is premalignant condition
- C. There is decreased gastric acid secretion (Correct Answer)
- D. It causes increased gastric acid secretion
Explanation: ***It is a premalignant condition*** - Menetrier's disease is characterized by **hyperplastic gastric mucosa** and is considered a **premalignant condition** due to its association with gastric cancers. - Regular surveillance and monitoring are recommended because of this increased risk for malignancy. *Affects the stomach and small intestines* - Menetrier's disease primarily **affects the stomach**, specifically leading to excessive growth of the gastric mucosa. - It does not typically involve the **small intestines**, which differentiates it from other gastrointestinal diseases. *There is increased gastric acid secretion* - In Menetrier's disease, there is actually a **decreased gastric acid secretion** due to the alteration of gastric mucosal structure. - This condition leads to **hypochlorhydria**, contrasting with conditions that increase acid secretion like Zollinger-Ellison syndrome. *Atrophied mucosal folds are seen* - Menetrier's disease is marked by **hypertrophy of the gastric folds**, not atrophy, resulting in **enlarged rugae** within the stomach. - Atrophied mucosal folds are more associated with conditions like chronic atrophic gastritis.
Surgery
5 questionsA 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is
Which of the following is NOT a principle of negative pressure wound therapy?
Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?
What is the treatment of choice in desmoid tumors?
Which of the following is resected in Whipple's operation, except?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1211: A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is
- A. Palliative Radiotherapy
- B. Chemotherapy and immunotherapy
- C. Partial nephrectomy
- D. Radical Nephroureterectomy (Correct Answer)
Explanation: ***Radical Nephroureterectomy*** - Carcinoma of the **renal pelvis** is a type of upper tract urothelial carcinoma (UTUC). Because of the multifocal nature and higher risk of recurrence of UTUC, **radical nephroureterectomy** (which includes removal of the kidney, ureter, and bladder cuff) is the standard treatment, even for smaller tumors. - Unlike renal cell carcinoma, partial nephrectomy is generally not recommended for renal pelvis carcinomas due to the risk of leaving behind residual disease in the ureter or bladder cuff. *Partial nephrectomy* - This is generally reserved for small, localized **renal cell carcinomas**, especially when kidney function preservation is a concern (e.g., solitary kidney, bilateral tumors). - For **renal pelvis carcinomas**, partial nephrectomy is associated with a higher risk of local recurrence because of the potential for tumor spread within the ureter and multifocal disease. *Chemotherapy and immunotherapy* - **Chemotherapy** (often cisplatin-based) might be used as neoadjuvant or adjuvant therapy for locally advanced or high-risk UTUC, or for metastatic disease. It is not the primary curative treatment for localized disease. - **Immunotherapy** is typically reserved for advanced or metastatic urothelial carcinoma that has progressed after chemotherapy. *Palliative Radiotherapy* - **Radiotherapy** has a limited role in the primary curative treatment of renal pelvis carcinoma. - It is mainly used in a **palliative setting** for symptom control (e.g., bone metastases, local pain) in advanced or metastatic disease, not for localized, resectable tumors.
Question 1212: Which of the following is NOT a principle of negative pressure wound therapy?
- A. Macrodeformation of the wound
- B. Decreased edema
- C. Stabilization of wound environment
- D. Clearance of infection (Correct Answer)
Explanation: ***Clearance of infection*** - While negative pressure wound therapy (NPWT) can help manage heavily colonized wounds by removing exudate and reducing bacterial burden, it is **not a primary treatment for active infection**. - **Systemic antibiotics** or local antiseptics are required to truly clear an infection, as NPWT alone cannot eliminate deep-seated pathogens. *Stabilization of wound environment* - NPWT helps to **stabilize the wound bed** by holding it in place, protecting it from external contamination and mechanical stress. - This creates an optimal environment for **wound healing** by preventing disruption of newly formed granulation tissue. *Macrodeformation of the wound* - The negative pressure applied to the wound surface causes the wound edges to be drawn together, leading to **macrodeformation**. - This effect reduces wound size and promotes **epithelialization** and **wound contraction**. *Decreased edema* - NPWT actively removes **excess interstitial fluid** and exudate from the wound bed, leading to a significant reduction in edema. - This reduction in swelling improves **perfusion** to the wound tissues and promotes better healing.
Question 1213: Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?
- A. Below the diaphragmatic aperture
- B. Pharyngoesophageal junction
- C. At the crossing of the arch of aorta
- D. Above the diaphragmatic aperture (Correct Answer)
Explanation: ***Above the diaphragmatic aperture*** - Boerhaave syndrome, or spontaneous esophageal rupture, most commonly occurs in the **distal esophagus**, just above the diaphragmatic aperture. - This region is particularly susceptible due to increased **intraluminal pressure** during forceful vomiting, combined with a lack of muscular support and a thinner esophageal wall. - The rupture typically occurs in the **left posterolateral wall** of the lower third of the esophagus, approximately **2-5 cm above the gastroesophageal junction**. *Below the diaphragmatic aperture* - Ruptures below the diaphragmatic aperture are less common in Boerhaave syndrome, as the **lower esophageal sphincter** and surrounding diaphragmatic crura provide more support. - While other forms of esophageal injury can occur here, a spontaneous rupture due to vomiting is less typical in this location. *Pharyngoesophageal junction* - Ruptures at the pharyngoesophageal junction are known as **Zenker's diverticulum ruptures** or other types of perforation, typically not Boerhaave syndrome. - This area is prone to tears from instrumentation or foreign bodies but not usually from the extreme pressure of forceful vomiting (which affects the distal esophagus more). *At the crossing of the arch of aorta* - The mid-esophagus at the level of the aortic arch is not a common site for Boerhaave syndrome. - Although the esophagus is constricted here, the primary stress during forceful vomiting is concentrated in the **distal esophagus**.
Question 1214: What is the treatment of choice in desmoid tumors?
- A. Irradiation
- B. Wide excision (Correct Answer)
- C. Local excision
- D. Local excision following radiation
Explanation: ***Wide excision*** - For **desmoid tumors**, **complete surgical resection with clear margins** is the primary treatment of choice due to their infiltrative nature and high recurrence rates. - This approach aims to minimize local recurrence and prevent tumor progression, which can impact adjacent structures. *Irradiation* - **Radiation therapy** is typically reserved as an **adjuvant** treatment after surgery or for unresectable tumors, not as a primary standalone treatment. - While it can help reduce recurrence rates, it carries risks of **secondary malignancies** and local tissue damage. *Local excision* - **Local excision** alone is insufficient for desmoid tumors due to their **infiltrative growth pattern** and high propensity for **local recurrence** if positive margins remain. - It often leads to incomplete removal, necessitating further intervention and increasing the risk of tumor progression. *Local excision following radiation* - Combining local excision with initial radiation is not the preferred sequence; **wide surgical excision** is typically performed first. - Radiation might be considered preoperatively in specific cases to **reduce tumor size** or postoperatively for **positive margins**, but starting with local excision after initial radiation is not the standard primary management.
Question 1215: Which of the following is resected in Whipple's operation, except?
- A. Duodenum
- B. Head of pancreas
- C. Neck of pancreas (Correct Answer)
- D. Common bile duct
Explanation: ***Neck of pancreas*** - In a **Whipple procedure** (pancreaticoduodenectomy), the **neck of the pancreas** is the site of transection (division), not resection. - The pancreas is divided at the neck, and the remaining **body and tail** are preserved and anastomosed to the jejunum for pancreatic drainage. *Duodenum* - The **entire duodenum** is resected during a Whipple operation as it shares intimate anatomical relations with the pancreatic head. - Complete duodenal removal is necessary to achieve adequate **oncological margins** and remove all associated lymphatic drainage. *Head of pancreas* - The **head of the pancreas** is the primary structure resected in a Whipple procedure. - This resection is typically performed for **pancreatic adenocarcinoma** or **periampullary tumors** requiring en bloc removal. *Common bile duct* - The **distal common bile duct** is resected as part of the specimen to ensure complete tumor excision. - The remaining **proximal bile duct** is reconstructed via **hepaticojejunostomy** to restore biliary drainage.