NEET-PG 2021 Practice Questions

Q: A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?

Palliative chemotherapy. Palliative chemotherapy - The presence of **multiple small metastases** in the liver indicates **metastatic disease**, which is generally considered incurable with surgery [2]. - **Palliative chemotherapy** aims to control disease progression, alleviate symptoms, and improve quality of life in patients with advanced metastatic cancer. Surgical resection with adjuvant chemotherapy - **Surgical resection** is not indicated due to the presence of **distant metastases** (to the liver), classifying the disease as Stage IV [1]. - **Adjuvant chemotherapy** is given after curative surgery to reduce recurrence risk, which is not the goal here as the disease is already metastatic. Radiation therapy alone - **Radiation therapy alone** is typically reserved for localized disease or for palliative symptom management (e.g., pain from bone metastases), not for widespread metastatic disease. - It would not adequately address the systemic nature of **multiple liver metastases** from a pancreatic primary. Supportive care only - While supportive care is crucial, **palliative chemotherapy** offers a chance to prolong survival and manage symptoms more effectively than supportive care alone in suitable patients with advanced pancreatic cancer. - Skipping chemotherapy entirely would mean foregoing potential benefits in terms of disease control and quality of life, especially for patients with a good performance status.

Q: An 85-year-old male with prostate cancer, Gleason score of 6 , and PSA <8 ng/mL. What is the best management approach?

Active surveillance/Watchful waiting. Androgen deprivation therapy - **Hormonal therapy** is primarily used for advanced, metastatic, or high-risk localized prostate cancer [1], or as an adjunct to radiation therapy. - It is not indicated as a primary first-line treatment for **low-risk, localized prostate cancer** in an elderly patient, as its side effects (e.g., hot flashes, fatigue, bone loss, cardiovascular effects) can significantly impact quality of life without offering a survival advantage in this specific scenario.

Q: Examine the abdominal X-ray shown. What is the most likely diagnosis based on the findings?

Intestinal Obstruction. ***Intestinal Obstruction*** - The abdominal X-ray demonstrates **distended loops of bowel** with **multiple air-fluid levels**, which are classic radiographic signs of intestinal obstruction. - The presence of multiple, wide air-fluid levels visible in a **stepladder pattern** is a hallmark of bowel obstruction. - **Valvulae conniventes** (transverse folds crossing the entire width of bowel) suggest **small bowel** involvement when visible with distension. *Small bowel ileus* - While ileus can show distended bowel loops, it typically presents with **gas distributed throughout the small and large bowel** without a clear transition point. - Ileus shows **less pronounced air-fluid levels** and lacks the characteristic stepladder pattern seen in mechanical obstruction. - The clinical context and presence of multiple distinct air-fluid levels favor mechanical obstruction over ileus. *Large bowel obstruction* - Large bowel obstruction would show **dilated colon** with **haustrations** (incomplete folds that don't cross the entire lumen). - The obstruction would typically show dilation **proximal to the obstruction** with collapsed bowel distally. - The pattern in this image is more consistent with small bowel or generalized intestinal obstruction rather than isolated large bowel obstruction. *Pneumoperitoneum* - Pneumoperitoneum (free air in the peritoneal cavity) appears as **air under the diaphragm** on upright films or as **Rigler's sign** (both sides of bowel wall visible) on supine films. - This is a sign of **bowel perforation**, not obstruction with air-fluid levels within the bowel lumen. - The air-fluid levels seen here are **intraluminal**, not free intraperitoneal air.

Q: Asymptomatic varicose veins would fall under which category of the CEAP classification system?

C2 (Varicose veins). ***C2 (Varicose veins)*** - The CEAP classification uses 'C' for clinical manifestations, with **C2 specifically indicating the presence of varicose veins**. - Since the patient has **asymptomatic varicose veins**, C2 accurately captures this clinical state without implying more severe complications. - Varicose veins are classified as C2 **regardless of whether they are symptomatic or asymptomatic**. *C1 (Telangiectasias or reticular veins)* - C1 refers to smaller veins, such as **telangiectasias (spider veins)** and **reticular veins**, which are distinct from the larger, tortuous varicose veins. - These are less prominent venous abnormalities compared to varicose veins. *C3 (Edema)* - C3 indicates the **presence of edema** due to venous insufficiency. - The question specifies **asymptomatic varicose veins** without mention of edema, making C3 incorrect. *C4 (Skin changes)* - C4 denotes **skin changes** related to chronic venous insufficiency, such as pigmentation, eczema, or lipodermatosclerosis. - These are more advanced signs of venous disease and are not present in a patient with only varicose veins without complications.

Q: Which nerve is most commonly injured during submandibular gland surgery?

Marginal mandibular branch of facial nerve. ***Marginal mandibular branch of facial nerve*** - The **marginal mandibular nerve** courses superficially over and along the superior border of the submandibular gland, making it the **most vulnerable** structure during surgery - It is at highest risk during elevation of the gland, ligation of the facial vessels, and dissection near the gland's superior border - Injury leads to **weakness or paralysis of the depressor muscles of the lower lip** (depressor anguli oris and depressor labii inferioris), causing an asymmetric smile and difficulty with lip movements - This is the **most common nerve injury** in submandibular gland surgery due to its superficial anatomical position *Incorrect: Lingual nerve* - The **lingual nerve** passes medial to the submandibular duct and deep to the gland - While it can be injured during dissection of the submandibular duct or deeper aspects of the gland, it is **less commonly injured** than the marginal mandibular nerve - Damage results in **loss of taste and general sensation** to the anterior two-thirds of the tongue on the ipsilateral side *Incorrect: Mylohyoid nerve* - The **mylohyoid nerve** travels on the inferior surface of the mylohyoid muscle, generally beneath and protected by this muscle - It supplies the mylohyoid and anterior belly of the digastric muscles - Injury is **uncommon** during routine submandibular gland excision due to its protected anatomical position *Incorrect: Hypoglossal nerve* - The **hypoglossal nerve** lies deep and inferior to the submandibular gland - It supplies motor innervation to the intrinsic and extrinsic muscles of the tongue - It is the **least commonly injured** nerve as it is well-protected by its deep position, unless dissection is carried excessively deep or inferiorly

Q: In which condition is gas under the diaphragm most commonly seen on imaging?

Secondary. ***Correct: Secondary*** - **Gas under the diaphragm** is a classic sign of a **perforated viscus**, which is a severe form of **secondary peritonitis**. - Secondary peritonitis typically arises from the **rupture or perforation of an abdominal organ**, allowing gas and contents to leak into the peritoneal cavity. *Incorrect: Tertiary* - **Tertiary peritonitis** refers to persistent or recurrent peritonitis after seemingly adequate surgical and antibiotic treatment for primary or secondary peritonitis. - It is associated with **immunocompromised states** or **low-virulence organisms** and does not typically present with free gas under the diaphragm. *Incorrect: Retained stone* - A **retained stone** (e.g., gallstone, renal stone) can cause obstruction or inflammation but does not directly lead to **gas under the diaphragm**. - While it might indirectly lead to perforation if neglected, it's not the most common direct cause of **free peritoneal gas**. *Incorrect: Primary* - **Primary peritonitis** (also known as spontaneous bacterial peritonitis) occurs without an apparent source of contamination within the abdominal cavity, often in patients with ascites and **liver cirrhosis**. - It is characterized by bacterial infection of the ascitic fluid but does not involve a perforated viscus or **free gas under the diaphragm**.

Q: Mr. Ramu, a 35-year-old male, sustained a straddle injury in a motor vehicle accident and presents to the emergency department with blood at the urethral meatus. What is the next appropriate step in his management?

Retrograde urethrogram. ***Retrograde urethrogram*** - **Blood at the urethral meatus** after a straddle injury is highly suggestive of **urethral injury**, and a retrograde urethrogram is the diagnostic test of choice to assess the integrity of the urethra. - This procedure involves injecting contrast into the urethra to visualize any extravasation, strictures, or complete disruptions before attempting catheterization. *CECT Abdomen* - A CECT abdomen is primarily used to assess **solid organ injuries** or **intra-abdominal bleeding**, which is not the primary concern suggested by blood at the urethral meatus. - While broad abdominal trauma may warrant a CECT, it does not directly evaluate urethral integrity. *FAST* - **FAST (Focused Assessment with Sonography for Trauma)** is a rapid ultrasound examination to detect **free fluid (blood)** in the peritoneal or pericardial cavities. - It is used to identify **intra-abdominal or pericardial hemorrhage** and guide resuscitation, but it does not visualize the urethra. *Abdomen X-ray* - An abdomen X-ray can detect **fractures of the pelvis** or foreign bodies, but it does not provide detailed imaging of soft tissues like the urethra. - It would not show urethral extravasation or disruption, making it insufficient for diagnosing urethral injury.

Question 1

Which of the following statements is true regarding the structure shown in the image?

Accepted Answer

Lingual nerve

Answer

Hypoglossal nerve

Answer

Nerve to mylohyoid

Answer

Inferior alveolar nerve

Answer

Glossopharyngeal nerve

Question 2

A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?

Accepted Answer

Palliative chemotherapy

Answer

Surgical resection with adjuvant chemotherapy

Answer

Radiation therapy alone

Answer

Supportive care only

Question 3

An 85-year-old male with prostate cancer, Gleason score of 6 , and PSA <8 ng/mL. What is the best management approach?

Accepted Answer

Active surveillance/Watchful waiting

Answer

Radical prostatectomy

Answer

External beam radiation therapy

Answer

Androgen deprivation therapy

Question 4

Examine the abdominal X-ray shown. What is the most likely diagnosis based on the findings?

Accepted Answer

Intestinal Obstruction

Answer

Small bowel ileus

Answer

Pneumoperitoneum

Answer

Large bowel obstruction

Question 5

Asymptomatic varicose veins would fall under which category of the CEAP classification system?

Accepted Answer

C2 (Varicose veins)

Answer

C1 (Telangiectasias or reticular veins)

Answer

C3 (Edema)

Answer

C4 (Skin changes)

Question 6

Which nerve is most commonly injured during submandibular gland surgery?

Accepted Answer

Marginal mandibular branch of facial nerve

Answer

Lingual nerve

Answer

Mylohyoid nerve

Answer

Hypoglossal nerve

Question 7

A patient is found to have an asymptomatic common bile duct (CBD) stone two years after cholecystectomy on routine imaging. What is the most appropriate initial management?

Accepted Answer

ERCP with sphincterotomy and stone extraction

Answer

Keep on active surveillance

Answer

Medical dissolution therapy with ursodeoxycholic acid

Answer

Surgical exploration and choledochotomy

Question 8

In which condition is gas under the diaphragm most commonly seen on imaging?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Retained stone

Answer

Primary

Question 9

A patient with a left hypochondrium contusion presents with systolic blood pressure of 70 mm Hg and pulse rate of 110 bpm. What is the best step in management?

Accepted Answer

Emergency surgical exploration

Answer

Conservative management with observation

Answer

Chest tube insertion

Answer

Antibiotic therapy

Question 10

Mr. Ramu, a 35-year-old male, sustained a straddle injury in a motor vehicle accident and presents to the emergency department with blood at the urethral meatus. What is the next appropriate step in his management?

Accepted Answer

Retrograde urethrogram

Answer

CECT Abdomen

Answer

FAST

Answer

Abdomen X-ray

NEET-PG 2021

Anatomy

Internal Medicine

Radiology

Surgery