NEET-PG 2024 Practice Questions

Q: A female presents with a 1 × 1 cm thyroid swelling. What is the next best step in management?

TSH. ***Correct Option: TSH*** - **Thyroid-stimulating hormone (TSH)** is the most sensitive initial test to assess thyroid function when a thyroid nodule is discovered. - An abnormal TSH level (either high or low) can guide further investigation into whether the nodule is associated with a functional thyroid disorder. - **TSH should be the first test** according to American Thyroid Association guidelines for thyroid nodule evaluation. *Incorrect Option: I-131* - **I-131 (radioactive iodine therapy)** is a treatment modality for hyperthyroidism or thyroid cancer, not a diagnostic step for initial thyroid swelling evaluation. - Administering I-131 before assessing thyroid function would be inappropriate and could lead to unnecessary or harmful intervention. *Incorrect Option: TSH & T4* - While TSH is crucial, adding **T4 (thyroxine)** as an initial step is often not necessary if TSH is normal, as TSH alone effectively screens for primary thyroid dysfunction. - Measuring both TSH and T4 is typically reserved for situations where TSH is abnormal or when central hypothyroidism is suspected. *Incorrect Option: T3 & T4* - Measuring **T3 (triiodothyronine)** along with T4 as an initial screening for a thyroid nodule is generally not recommended. - T3 levels are primarily used to diagnose **hyperthyroidism** or to evaluate the severity of thyrotoxicosis after an abnormal TSH and T4 have been identified. *Incorrect Option: FNAC* - While **Fine Needle Aspiration Cytology (FNAC)** is an essential diagnostic tool for thyroid nodules, it is typically performed after TSH assessment. - FNAC is indicated for nodules >1 cm with suspicious ultrasound features, but **functional assessment with TSH comes first** to rule out hyperfunctioning nodules.

Q: A patient presents to the OPD with recurrent diarrhea, abdominal pain, and foul-smelling stools. The colonoscopy reveals the following findings. What is the most likely diagnosis?

Pseudomembranous colitis. ***Pseudomembranous colitis*** - The image clearly shows **yellowish-white plaques or pseudomembranes** scattered over the inflamed colonic mucosa, which are characteristic endoscopic findings of **pseudomembranous colitis**. - The clinical symptoms of **recurrent diarrhea**, **abdominal pain**, and **foul-smelling stools** are consistent with this diagnosis, often caused by *Clostridioides difficile* infection. *FAP (Familial Adenomatous Polyposis)* - FAP is characterized by hundreds to thousands of **adenomatous polyps** throughout the colon, usually **smaller and more uniform** in appearance than the pseudomembranes seen here. - While it can cause diarrhea and abdominal pain, the endoscopic appearance of discrete polyps rather than diffuse pseudomembranes differentiates it from the image shown. *Ulcerative colitis* - Ulcerative colitis typically presents with **continuous inflammation** of the colon, often involving **ulcerations, friability, and loss of haustra**, without the distinct pseudomembranes. - Symptoms usually include **bloody diarrhea** and tenesmus, which differ from the foul-smelling stools mentioned. *Acute gastritis* - Acute gastritis is an inflammation of the **stomach lining**, not the colon, and would not be diagnosed via colonoscopy. - Symptoms are usually upper GI-related, such as **epigastric pain, nausea, and vomiting**, not recurrent diarrhea and foul-smelling stools.

Q: A 6-week-old child with a history of vomiting undergoes an ultrasound, which shows an antral nipple sign or target sign, as shown in the image. What is the diagnosis?

Congenital pyloric stenosis. ***Congenital pyloric stenosis*** - The ultrasound findings of an **antral nipple sign** and **target sign** are classic indicators of **hypertrophic pyloric stenosis**. - This condition presents with **projectile vomiting** in infants, typically between 3-6 weeks of age, due to hypertrophy of the pyloric muscle. *Umbilical hernia* - An **umbilical hernia** is a protrusion of abdominal contents through the umbilical ring. It is usually diagnosed clinically and presents as a bulge, not with vomiting. - Ultrasound for an umbilical hernia would show bowel loops or omentum protruding through the abdominal wall defect, not the specific pyloric signs described. *Small bowel obstruction* - While small bowel obstruction can cause vomiting, the ultrasound findings would typically show **dilated loops of bowel** and a **transition point**, not an antral nipple or target sign specifically at the pylorus. - Other clinical features, such as abdominal distention and absence of stool, would also be more prominent. *Jejunal atresia* - **Jejunal atresia** is a congenital anomaly where part of the jejunum is underdeveloped or absent, leading to a complete obstruction. - Ultrasound would reveal **dilated loops of small bowel**, typically without peristalsis past the obstruction, and polyhydramnios antenatally, but not the specific pyloric ultrasound signs. *Duodenal atresia* - **Duodenal atresia** is a congenital obstruction of the duodenum that typically presents with bilious vomiting soon after birth. - The characteristic ultrasound finding is the **"double bubble" sign**, representing a distended stomach and proximal duodenum, not the target or antral nipple sign seen at the pylorus.

Q: In the intraoperative image of congenital hernia repair, the structure marked by the red arrow is identified as which of the following?

Testicular vein. ***Testicular vein*** - The **testicular vein** is clearly visible within the **spermatic cord** structures, which are typically identified and often dissected during congenital hernia repair. - Its position coursing with the testicular artery and vas deferens is consistent with its anatomical location within the inguinal canal. *Femoral vein* - The **femoral vein** lies more inferiorly and medially within the femoral canal, distinct from the inguinal canal contents visualized in this image. - Identification of the femoral vein would be in the context of a femoral hernia repair, not typically a congenital (indirect inguinal) hernia. *Obturator vein* - The **obturator vein** is located deep within the pelvis, accompanying the obturator nerve and artery through the obturator foramen. - It is not typically encountered or visible during a standard open or laparoscopic inguinal hernia repair. *Inferior epigastric vein* - The **inferior epigastric vein** runs superiorly and medially, forming the medial border of the **inguinal triangle (Hesselbach's triangle)**. - While it's an important landmark in hernia repair (differentiating direct vs. indirect hernias), its anatomical position and trajectory are distinct from the structure indicated by the arrow, which is part of the spermatic cord.

Q: How does a skin graft receive nutrition on day 3 after transplantation?

Inosculation. ***Inosculation*** - **Inosculation** is the process where host capillaries directly connect with the graft's existing vessels (or newly formed ones) around day 2-3 post-transplantation. - This establishes blood flow and is the primary mechanism for **nutrient delivery** and waste removal by day 3. *Imbibition* - **Imbibition** is the initial phase (first 24-48 hours) where the graft passively absorbs nutrients from the recipient bed through diffusion. - While essential for initial survival, it is typically insufficient for sustained graft viability by day 3. *Neovascularization* - **Neovascularization** involves the formation of entirely new blood vessels into the graft, a process that typically begins after inosculation and continues for several days to weeks. - On day 3, while *initiation* of new vessel formation may be occurring, the main nutritional support is primarily from established connections through inosculation. *A & B* - While **imbibition** plays a role in the initial survival of the graft, by day 3, **inosculation** is the dominant and more effective mechanism for nutrient supply. - Therefore, selecting both A and B would be incorrect as imbibition's role diminishes significantly as inosculation progresses.

Q: A patient presents with constant chest pain, and the radiological finding is as shown in the image. What is the most appropriate management?

Surgical management. ***Surgical management*** - The chest X-ray shows a **widened mediastinum** and abnormal aortic contour, highly suggestive of **aortic dissection involving the ascending aorta (Type A)**. - **Type A aortic dissection** (involving the ascending aorta) is a **surgical emergency** requiring immediate operative repair to prevent life-threatening complications such as cardiac tamponade, acute aortic regurgitation, or rupture. - The constant chest pain with these radiological findings indicates urgent surgical intervention is the definitive management. *Vasodilator* - Vasodilators **alone** should never be used in aortic dissection as they can increase aortic wall shear stress and propagate the dissection. - They must always be preceded by beta-blockade to prevent reflex tachycardia. - Vasodilators do not address the structural defect requiring surgical correction in Type A dissection. *Beta blocker* - Beta-blockers are essential for **initial medical stabilization** to reduce heart rate (target <60 bpm) and blood pressure, thereby decreasing aortic wall stress (dP/dt). - However, in **Type A dissection**, beta-blockers alone do not address the structural defect and are used as a bridge to emergency surgery, not as definitive treatment. - For Type B dissections (descending aorta), medical management with beta-blockers may be definitive in uncomplicated cases. *Beta blocker plus vasodilator* - This combination represents optimal **medical management** for blood pressure and heart rate control in aortic dissection. - In **Type B (descending) aortic dissections**, this is often the definitive treatment for uncomplicated cases. - However, in **Type A dissections** (as indicated by the widened mediastinum suggesting ascending aortic involvement), this serves only as initial stabilization before **mandatory surgical repair**, not as definitive therapy. - Surgery cannot be delayed in Type A dissection due to high mortality risk (1-2% per hour).

Q: Identify the procedure shown in the image, which is performed in a patient with recurrent GERD.

Nissen fundoplication. ***Nissen fundoplication*** - The image clearly depicts the **fundus of the stomach** being wrapped completely around the lower esophagus and sutured in place, which is the hallmark of a **360-degree Nissen fundoplication**. - This procedure aims to strengthen the **lower esophageal sphincter (LES)** to prevent reflux in patients with recurrent GERD. *Partial gastrectomy* - This procedure involves the **surgical removal of a portion of the stomach** and is typically performed for conditions like gastric cancer or severe ulcers, not primarily for GERD. - The image shows the stomach intact and being wrapped, not resected. *Esophageal banding* - Esophageal banding is a procedure used to treat **esophageal varices** by placing elastic bands around dilated veins, not a surgical intervention for GERD that alters stomach anatomy. - The image shows a gastric maneuver, not banding of the esophagus. *Toupet fundoplication* - A Toupet fundoplication involves a **partial (270-degree) wrap** of the fundus around the esophagus, leaving a small portion unwrapped. - The image distinctly illustrates a **complete 360-degree wrap**, distinguishing it from a Toupet fundoplication.

Q: A patient presents with a penile lesion staged as T3, with clinically palpable lymph nodes. What is the most appropriate management?

Penectomy with deep ilioinguinal node dissection. ***Penectomy with deep ilioinguinal node dissection*** - A **T3 penile lesion** indicates invasion of the corpus cavernosum or corpus spongiosum, which is an aggressive stage requiring **radical local excision (penectomy)**. - **Clinically palpable lymph nodes** alongside a T3 tumor suggest nodal involvement (N1-N3), necessitating a **deep ilioinguinal lymph node dissection** to remove affected deeper lymph nodes that are not readily accessible by superficial dissection. *Penectomy* - While penectomy addresses the primary tumor, it does not manage the **clinically palpable lymph nodes**, which are crucial for staging and prognosis in advanced penile cancer. - This option would be insufficient given the documented **nodal involvement**, leading to likely recurrence and progression of the disease. *Penectomy with superficial node dissection* - This approach is inadequate for **palpable lymph nodes**, especially with a T3 lesion, because such nodes often indicate involvement of **deeper lymphatics (deep ilioinguinal)**. - Superficial dissection alone would likely leave residual disease, failing to properly stage and treat the extent of the cancer. *Chemoradiotherapy* - **Chemoradiotherapy** is typically reserved for patients who are not surgical candidates, or as a neoadjuvant/adjuvant therapy, not as primary treatment for a **T3 lesion with palpable nodes** where surgical intervention is the standard of care for optimal local and regional control. - While it may be used in certain settings, surgery (penectomy with lymph node dissection) offers the best chance for cure in this scenario.

Question 1

What is the most appropriate initial investigation for a solitary thyroid nodule (STN)?

Accepted Answer

Ultrasound

Answer

I-123 scan

Answer

Fine-needle aspiration (FNA) biopsy

Answer

Thyroid function tests (TFTs)

Answer

CT scan of the neck

Question 2

A female presents with a 1 × 1 cm thyroid swelling. What is the next best step in management?

Accepted Answer

TSH

Answer

I-131

Answer

TSH & T4

Answer

T3 & T4

Answer

FNAC

Question 3

A patient presents to the OPD with recurrent diarrhea, abdominal pain, and foul-smelling stools. The colonoscopy reveals the following findings. What is the most likely diagnosis?

Accepted Answer

Pseudomembranous colitis

Answer

FAP (Familial Adenomatous Polyposis)

Answer

Ulcerative colitis

Answer

Acute gastritis

Question 4

A 6-week-old child with a history of vomiting undergoes an ultrasound, which shows an antral nipple sign or target sign, as shown in the image. What is the diagnosis?

Accepted Answer

Congenital pyloric stenosis

Answer

Umbilical hernia

Answer

Small bowel obstruction

Answer

Jejunal atresia

Answer

Duodenal atresia

Question 5

In the intraoperative image of congenital hernia repair, the structure marked by the red arrow is identified as which of the following?

Accepted Answer

Testicular vein

Answer

Femoral vein

Answer

Obturator vein

Answer

Inferior epigastric vein

Question 6

An elderly patient presents with a non-healing ulcerative lesion on the lower lip, as shown in the image. The lesion has been gradually enlarging over the past few months. Suspecting squamous cell carcinoma (SCC), what is the most appropriate method to obtain a biopsy for definitive diagnosis?

Accepted Answer

Incisional

Answer

Excisional

Answer

Deep tissue biopsy

Answer

Superficial biopsy from the border with normal tissue

Question 7

How does a skin graft receive nutrition on day 3 after transplantation?

Accepted Answer

Inosculation

Answer

Imbibition

Answer

Neovascularization

Answer

A & B

Question 8

A patient presents with constant chest pain, and the radiological finding is as shown in the image. What is the most appropriate management?

Accepted Answer

Surgical management

Answer

Vasodilator

Answer

Beta blocker

Answer

Beta blocker plus vasodilator

Question 9

Identify the procedure shown in the image, which is performed in a patient with recurrent GERD.

Accepted Answer

Nissen fundoplication

Answer

Partial gastrectomy

Answer

Esophageal banding

Answer

Toupet fundoplication

Question 10

A patient presents with a penile lesion staged as T3, with clinically palpable lymph nodes. What is the most appropriate management?

Accepted Answer

Penectomy with deep ilioinguinal node dissection

Answer

Penectomy

Answer

Penectomy with superficial node dissection

Answer

Chemoradiotherapy

NEET-PG 2024

Diagnosis

Internal Medicine

Pediatrics

Surgery