Community Medicine
1 questionsMost common cause of goiter in India is
NEET-PG 2015 - Community Medicine NEET-PG Practice Questions and MCQs
Question 1231: Most common cause of goiter in India is
- A. Diffuse Endemic Goitre (Correct Answer)
- B. Papillary Carcinoma
- C. Toxic Multinodular Goitre
- D. Hashimoto's Thyroiditis
Explanation: ***Diffuse Endemic Goitre*** - **Iodine deficiency** is the leading cause of goiter globally, particularly in areas with poor iodine intake like some regions in India, leading to **diffuse endemic goiter** - In response to low iodine, the thyroid gland undergoes **hypertrophy** and **hyperplasia**, increasing in size in an attempt to capture more iodine for thyroid hormone synthesis - Despite the **Universal Salt Iodization (USI) program**, iodine deficiency disorders remain a significant public health concern in several Indian states *Papillary Carcinoma* - While it can cause a thyroid mass, **papillary carcinoma** is a malignant neoplastic condition, not the most common cause of generalized goiter - It presents as a **solitary or dominant nodule** and is not typically associated with widespread iodine deficiency - Accounts for only a small percentage of thyroid enlargements *Toxic Multinodular Goitre* - This condition involves multiple autonomously functioning nodules and primarily causes **hyperthyroidism**, not just goiter as a primary common presentation - More common in **elderly patients** and in regions with prior iodine deficiency (Jod-Basedow phenomenon) - Does not represent the most widespread cause of goiter in the general population of India *Hashimoto's Thyroiditis* - Hashimoto's is an **autoimmune disease** causing chronic lymphocytic thyroid inflammation and often hypothyroidism - While it can cause goiter, it typically produces a **firmer, less diffuse enlargement** than that seen with **iodine deficiency** - Not the most common cause of goiter in India, though its prevalence is increasing in urban areas
Internal Medicine
4 questionsA 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is
All of the following may lead to pneumatocele formation except which of the following?
Most common precipitant of Raynaud's phenomenon is
What is the main contraindication for performing a liver biopsy?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1231: A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is
- A. Benign Thyroid Nodule
- B. Solitary Toxic Adenoma (Correct Answer)
- C. Follicular Carcinoma
- D. Toxic Multinodular Goiter
Explanation: A **solitary toxic adenoma** is a single thyroid nodule that autonomously produces thyroid hormones, leading to **hyperthyroidism**. The increased iodine uptake on scan reflects its hyperfunctional state, and elevated **T3/T4** confirms hyperthyroidism. [2] - The combination of a **solitary nodule**, **increased iodine uptake**, and **elevated thyroid hormone levels** is pathognomonic for a solitary toxic adenoma. [2] *Benign Thyroid Nodule* - A **benign thyroid nodule** without hyperfunction would typically show **normal or decreased iodine uptake** and **normal T3/T4** levels. [2] - While benign, such a nodule alone does not explain the **elevated T3/T4** or **increased iodine uptake**. *Follicular Carcinoma* - **Follicular carcinoma** is a type of thyroid cancer that typically presents as a **cold nodule** (decreased iodine uptake) and is usually **non-functional**, meaning it does not cause hyperthyroidism with elevated T3/T4. [2] - The presence of **increased iodine uptake** and **hyperthyroidism** makes follicular carcinoma highly unlikely. *Toxic Multinodular Goiter* - A **toxic multinodular goiter** involves **multiple nodules**, not a solitary one, that are autonomously functional and cause hyperthyroidism. [1] - While it causes **hyperthyroidism** and **increased iodine uptake**, the key differentiating factor here is the presentation as a **solitary nodule**.
Question 1232: All of the following may lead to pneumatocele formation except which of the following?
- A. Staphylococcal pneumonia
- B. Positive pressure ventilation
- C. Hydrocarbon inhalation
- D. ARDS (Correct Answer)
Explanation: ***ARDS*** - **Acute Respiratory Distress Syndrome (ARDS)** is primarily characterized by **inflammatory lung injury**, leading to **alveolar edema**, but does not typically cause pneumatocele formation [1]. - Pneumatoceles are more likely associated with infections or mechanical ventilation, not with ARDS itself. *Staphylococcal pneumonia* - **Staphylococcal pneumonia** can lead to pneumatocele formation due to **necrotizing pneumonia**, where the formation of air-filled cysts occurs from lung tissue damage. - This type of pneumonia is associated with **Staphylococcus aureus** and can cause cavitary lesions. *Positive pressure ventilation* - **Positive pressure ventilation** can increase the risk of barotrauma, leading to the formation of pneumatocele through excess air entering lung tissue. - It is often used in cases of respiratory distress but can inadvertently contribute to pneumatocele development. *Hydrocarbon inhalation* - **Hydrocarbon inhalation** is linked to pneumonitis and can cause lung injury, leading to the formation of **pneumatoceles** as a result of **lung inflammation**. - Such inhalation can create **alveolar damage**, allowing for air-filled spaces to develop.
Question 1233: 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 1234: 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].
Surgery
5 questionsA 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?
Which of the following stages of lip carcinoma does not have nodal involvement?
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
Which of the following is NOT a principle of negative pressure wound therapy?
Where does spontaneous esophageal rupture (Boerhaave syndrome) most commonly occur?
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1231: A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?
- A. Tension Pneumothorax (Correct Answer)
- B. Flail Chest
- C. Myocardial Infarction
- D. Cardiac Tamponade
Explanation: ***Tension Pneumothorax*** - The classic triad of **breathlessness**, **decreased breath sounds** on the affected side, and **hyperresonance** on percussion following chest trauma is highly indicative of a tension pneumothorax. - **Distended neck veins** (jugular venous distension) occur due to increased intrathoracic pressure impeding venous return to the heart. *Cardiac Tamponade* - Characterized by **Beck's triad**: hypotension, muffled heart sounds, and jugular venous distension. - While **distended neck veins** are present, the absence of muffled heart sounds, the presence of decreased breath sounds, and hyperresonance point away from tamponade. *Flail Chest* - Defined by at least two contiguous ribs fractured in at least two places, leading to a **paradoxical movement** of the chest wall during respiration. - The key diagnostic feature of flail chest (paradoxical chest wall movement) is not described, nor are the breath sounds or percussion findings consistent with this diagnosis. *Myocardial Infarction* - Typically presents with **sudden chest pain**, often radiating to the left arm or jaw, and may cause breathlessness. - It does not cause **decreased breath sounds**, **hyperresonance**, or directly lead to these specific localized chest findings after trauma.
Question 1232: Which of the following stages of lip carcinoma does not have nodal involvement?
- A. T2N1
- B. T3N0 (Correct Answer)
- C. T2N2
- D. T1N1
Explanation: ***T3N0*** - The **'N' classification** in the TNM staging system refers to **nodal involvement**. A stage with **'N0' indicates no regional lymph node metastasis**. - A **T3 lesion** signifies a large primary tumor, but if it's accompanied by **N0**, it means there's no evidence of spread to the lymph nodes. *T2N1* - The **'N1' classification** indicates the presence of **regional lymph node metastasis**, specifically in a **single ipsilateral lymph node** that is 3 cm or less in its greatest dimension. - This stage therefore **does have nodal involvement**, contradicting the premise of the question. *T2N2* - The **'N2' classification** signifies more advanced regional lymph node metastasis, such as a **single ipsilateral lymph node** greater than 3 cm but not more than 6 cm. - It could also refer to **multiple ipsilateral lymph nodes**, none greater than 6 cm, or bilateral/contralateral lymph nodes, none greater than 6 cm. In all these cases, **nodal involvement is present**. *T1N1* - Similar to T2N1, the **'N1' component** in T1N1 indicates the presence of **regional lymph node metastasis** in a single ipsilateral lymph node of 3 cm or less. - Therefore, this stage **does involve nodal spread**, despite having a smaller primary tumor (T1).
Question 1233: 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 1234: 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 1235: 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**.