NEET-PG 2012 Practice Questions

Q: A person inhaled a peanut two days ago and is now unable to cough it out. Where is the possible location?

Right lower lobe. ***Right lower lobe*** - Due to the **angle** of the right main bronchus, which is less acute than the left, aspirated foreign bodies, like a peanut, tend to preferentially enter the **right bronchial tree**. - Within the right lung, foreign bodies are most commonly found in the **right lower lobe** because its **bronchus is the most direct continuation** of the right main bronchus, especially in an upright position. *Right superior lobe* - While material can go into the right lung, the **right upper lobe bronchus** branches off at a more acute angle, making aspiration into this lobe less common than into the lower lobes when a person is in an upright or semi-recumbent position. - Aspiration into the superior lobes is more common with specific body positions or in cases of massive aspiration. *Right middle lobe* - The **right middle lobe bronchus** is smaller and branches off at an angle that is less favorable for direct aspiration compared to the right lower lobe. - Aspiration to this lobe is less frequent than to the lower lobes. *Left lower lobe* - The **left main bronchus** is narrower and branches off at a much more acute angle from the trachea compared to the right main bronchus. - This anatomical difference makes aspiration into the left lung, including the **left lower lobe**, significantly less common than into the right lung.

Q: What is true about HER2/neu overexpression in cancer?

Responds well to monoclonal antibodies. ***Responds well to monoclonal antibodies*** - HER2/neu overexpression is targeted by **monoclonal antibodies** like trastuzumab (Herceptin), improving treatment outcomes [1]. - These therapies are specifically designed to **inhibit HER2-positive** tumors, leading to better overall prognosis compared to those without such therapies [1]. *Good prognosis* - HER2/neu overexpression is generally associated with a **poor prognosis** due to increased aggressiveness of the cancer. - It correlates with **higher rates of recurrence** and metastasis compared to HER2-negative breast cancers. *Responds well to taxanes* - While taxanes are commonly used in breast cancer treatment, HER2/neu positivity does not specifically imply a good response. - Response rates may not significantly differ based on HER2 status for taxane-based therapies alone. *Seen only in breast cancer* - HER2/neu overexpression can also occur in other cancers, such as **gastric and gastroesophageal junction cancers**. - It is not exclusive to breast cancer, though it is most commonly studied in this context [1].

Q: Which of the following is the most common type of tongue cancer?

Squamous cell carcinoma. ***Adenocarcinoma most common*** - The most common type of tongue cancer is **squamous cell carcinoma (SCC)**, not adenocarcinoma [1]. - Adenocarcinomas are less frequently associated with the tongue compared to SCC, which constitutes the majority of cases. *Tobacco is the cause* - Tobacco use is indeed a **significant risk factor** for various head and neck cancers, including tongue cancer [1]. - Smoking and smokeless tobacco are linked to increased incidence and severity of **squamous cell carcinoma** on the tongue [1]. *Deep cervical lymph nodes not involved* - Tongue cancers often metastasize to **deep cervical lymph nodes**, particularly in advanced stages. - Involvement of lymph nodes is a common feature that can affect prognosis and treatment strategies. *Lateral surface involved* - The **lateral surface** of the tongue is a common site for cancerous lesions, especially in cases related to tobacco use. - Tumors might also arise from other surfaces, but lateral involvement is characteristic of **squamous cell carcinoma**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 738-739.

Q: A 24-day-old neonate presents with projectile vomiting and failure to gain weight. What is the most likely diagnosis?

Congenital Hypertrophic Pyloric Stenosis. ***Congenital Hypertrophic Pyloric Stenosis*** - The classic presentation includes **projectile, non-bilious vomiting** in a neonate around 2-8 weeks old, leading to **failure to thrive**. - An **olive-shaped mass** (hypertrophied pylorus) may be palpable in the epigastrium. *NEC* - **Necrotizing enterocolitis (NEC)** is an inflammatory disease of the intestine, primarily affecting premature infants. - Symptoms typically include **abdominal distension**, bloody stools, and lethargy, rather than projectile vomiting. *Duodenal atresia* - Presents with **bilious vomiting** within the first 24-48 hours of life due to an obstruction below the ampulla of Vater. - An X-ray would show a **"double bubble" sign**, which is not implied by the provided symptoms. *Hirschsprung's disease* - Characterized by **failure to pass meconium** within the first 24-48 hours and chronic constipation. - Vomiting, if present, is usually **bilious** and associated with abdominal distension, not projectile in nature.

Q: What are the first-line disease-modifying treatments for Guillain-Barre Syndrome (GBS) in a child?

Intravenous Immunoglobulin (IV Ig) and Plasmapheresis. ***Intravenous Immunoglobulin (IV Ig) and Plasmapheresis*** - Both **IV Ig** and **plasmapheresis** are equally effective first-line disease-modifying treatments for GBS in children - **IV Ig** works by neutralizing pathogenic antibodies and modulating the immune response - **Plasmapheresis** removes circulating antibodies and inflammatory mediators from the plasma - Both treatments reduce the severity and duration of paralysis and accelerate recovery - They are equally effective with **no significant difference in outcomes**; choice depends on availability, contraindications, and patient factors *Intravenous Immunoglobulin (IV Ig) alone* - While IV Ig is indeed a first-line treatment, it is not the only one - The question asks for treatments (plural), and plasmapheresis is equally effective *Mechanical Ventilation alone* - This is a **supportive measure** for respiratory failure, not a disease-modifying treatment - About 20-30% of GBS patients require mechanical ventilation due to respiratory muscle weakness - It manages complications but does not treat the underlying immune-mediated neuropathy *Plasmapheresis alone* - While plasmapheresis is indeed a first-line treatment, it is not the only one - The question asks for treatments (plural), and IV Ig is equally effective

Q: Opsoclonus-myoclonus is a phenomenon seen in:

Neuroblastoma. ***Neuroblastoma*** - **Opsoclonus-myoclonus syndrome (OMS)** is a rare paraneoplastic neurological disorder primarily associated with childhood neuroblastoma. - It is characterized by rapid, irregular eye movements (**opsoclonus**), brief, involuntary muscle jerks (**myoclonus**), ataxia, and irritability. *Wilm's tumor* - Wilms' tumor (nephroblastoma) is a kidney tumor of childhood and is not typically associated with opsoclonus-myoclonus syndrome. - While it is also a pediatric cancer, its paraneoplastic manifestations are different and do not include OMS. *Meningioma* - Meningiomas are typically slow-growing tumors arising from the meninges in adults, and are not associated with opsoclonus-myoclonus. - Paraneoplastic syndromes are rare with meningiomas, and OMS is not one of them. *Cortical tuberculoma* - A cortical tuberculoma is a granulomatous lesion in the brain caused by Mycobacterium tuberculosis, often seen in individuals with tuberculosis. - While it can cause neurological symptoms like seizures, headaches, and focal deficits, it does not cause opsoclonus-myoclonus syndrome.

Q: What is the correct sequence of medication administration for pre-operative prophylaxis in pheochromocytoma?

Alpha blockade followed by beta blockade. ***Alpha blockade followed by beta blockade*** - **Alpha blockade** should always be initiated first to control **hypertension** and prevent a **hypertensive crisis** during surgery. This is critical because pheochromocytoma causes excessive catecholamine release, leading to profound vasoconstriction. - **Beta blockade** is then added only after adequate alpha blockade has been achieved to control **tachycardia** and arrhythmias, preventing **unopposed alpha-adrenergic stimulation** which could paradoxically worsen hypertension. *Simultaneous alpha and beta blockade* - Administering both simultaneously is dangerous because **beta blockade** can mask the effects of inadequate alpha blockade. - This can lead to **unopposed alpha-adrenergic stimulation** after beta blockade, causing severe **vasoconstriction** and hypertensive crisis. *Beta blockade followed by alpha blockade* - Initiating with **beta blockade** without prior **alpha blockade** is absolutely contraindicated in pheochromocytoma. - This can lead to severe and potentially fatal **hypertension** due to **unopposed alpha-adrenergic stimulation** as beta blockade prevents vasodilation. *Alpha blockade only* - While essential for initial management, **alpha blockade alone** might not fully control all symptoms, especially **tachycardia** and **arrhythmias** caused by high circulating catecholamine levels. - Adding a **beta blocker** after achieving adequate alpha blockade helps in controlling these cardiac effects, optimizing patient preparation for surgery.

Q: In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

T4b. ***T4b*** * The **TNM staging system** classifies T4b specifically for inflammatory breast cancer, which is characterized by the presence of **peau d'orange** (edema) of the skin of the breast. * This T stage also encompasses **ulceration of the skin** of the breast or satellite nodules confined to the same breast. *T4a* * T4a describes an **extension to the chest wall**, which includes the ribs, intercostal muscles, and serratus anterior muscle, but **not** the pectoralis muscle, which is generally not considered part of the chest wall for this classification. * This stage does **not** include the characteristic skin changes associated with inflammatory breast cancer. *T3* * T3 describes a tumor with a **size greater than 5 cm** in its greatest dimension, without direct extension to the chest wall or skin involvement. * This stage is based solely on tumor size and **does not account for the skin changes** like peau d'orange. *T2* * T2 describes a tumor with a **size greater than 2 cm but not more than 5 cm** in its greatest dimension. * Similar to T3, this stage is also based on tumor size and **does not include any skin involvement** or inflammatory features.

Q: What is the first-line intervention for acute symptomatic hydroureter with ureteral obstruction requiring urgent decompression?

Endoscopic ureteral stenting. ***Endoscopic ureteral stenting*** - **Endoscopic ureteral stenting** is the primary intervention for **acute symptomatic ureteral obstruction** requiring urgent decompression when the obstruction causes **hydroureter**. - This minimally invasive procedure provides immediate drainage from the kidney to the bladder, preventing further renal damage, managing pain, and relieving obstruction. - **Indications for urgent stenting** include: infected hydronephrosis, impaired renal function, intractable pain, solitary kidney with obstruction, or bilateral obstruction. - Alternative to stenting is **percutaneous nephrostomy**, particularly when retrograde stent placement fails or in infected systems. *Antibiotic prophylaxis alone* - While antibiotics are essential when infection complicates obstruction (pyonephrosis), **antibiotics alone cannot relieve the mechanical obstruction**. - The physical blockage must be addressed to prevent progressive renal damage and sepsis. *Immediate ureterolithotomy* - **Open ureterolithotomy** is a definitive surgical treatment but is **not first-line** for acute obstruction. - It is more invasive and typically reserved for failed endoscopic management, large impacted stones, or anatomical abnormalities preventing endoscopic access. - Modern approach favors initial decompression followed by definitive treatment (ureteroscopy, ESWL, or surgery). *Urinary alkalization* - **Urinary alkalization** may help dissolve **uric acid stones** over time but does not provide immediate relief of acute obstruction. - This is an adjunctive measure for specific stone types, not an emergency intervention for symptomatic hydroureter.

Q: Which of the following hernias has the highest risk of strangulation?

Spigelian. ***Spigelian*** - **Spigelian hernias** occur through a defect in the **Spigelian aponeurosis** (between the semilunar line and lateral border of rectus abdominis), typically inferior to the arcuate line. - They have a **high risk of strangulation (20-25%)** due to their **narrow fascial defect** and tendency to become incarcerated through the layers of the abdominal wall. - The hernia often becomes **interparietal** (between muscle layers), making it difficult to detect clinically, which increases the risk of delayed presentation and strangulation. *Indirect* - **Indirect inguinal hernias** pass through the **deep inguinal ring** and follow the inguinal canal, potentially entering the scrotum. - While they do have a narrow neck that can cause strangulation, their **strangulation risk is moderate (~10-15%)**, lower than Spigelian hernias. - They are the most common type of hernia but not the highest risk for strangulation among these options. *Direct* - **Direct inguinal hernias** protrude through **Hesselbach's triangle** in the posterior wall of the inguinal canal. - They have a **broad-based neck**, making strangulation relatively uncommon (~5%). - The wider defect allows easier reduction and less constriction of contents. *Incisional* - **Incisional hernias** develop at previous surgical incision sites due to fascial weakness or inadequate healing. - While they can incarcerate, they typically have a **wider neck** and **lower strangulation risk** compared to Spigelian or indirect inguinal hernias. - Risk varies with defect size, but generally not the highest among common hernia types.

Question 1

A person inhaled a peanut two days ago and is now unable to cough it out. Where is the possible location?

Accepted Answer

Right lower lobe

Answer

Right superior lobe

Answer

Left lower lobe

Answer

Right middle lobe

Question 2

What is true about HER2/neu overexpression in cancer?

Accepted Answer

Responds well to monoclonal antibodies

Answer

Good prognosis

Answer

Responds well to taxanes

Answer

Seen in various cancers, including breast cancer

Question 3

Which of the following is the most common type of tongue cancer?

Accepted Answer

Squamous cell carcinoma

Answer

Lymphoma

Answer

Adenocarcinoma

Answer

Basal cell carcinoma

Question 4

A 24-day-old neonate presents with projectile vomiting and failure to gain weight. What is the most likely diagnosis?

Accepted Answer

Congenital Hypertrophic Pyloric Stenosis

Answer

NEC

Answer

Duodenal atresia

Answer

Hirschsprung's disease

Question 5

What are the first-line disease-modifying treatments for Guillain-Barre Syndrome (GBS) in a child?

Accepted Answer

Intravenous Immunoglobulin (IV Ig) and Plasmapheresis

Answer

Intravenous Immunoglobulin (IV Ig) alone

Answer

Mechanical Ventilation alone

Answer

Plasmapheresis

Question 6

Opsoclonus-myoclonus is a phenomenon seen in:

Accepted Answer

Neuroblastoma

Answer

Wilms' tumor

Answer

Meningioma

Answer

Cortical tuberculoma

Question 7

What is the correct sequence of medication administration for pre-operative prophylaxis in pheochromocytoma?

Accepted Answer

Alpha blockade followed by beta blockade

Answer

Beta blockade followed by alpha blockade

Answer

Simultaneous alpha and beta blockade

Answer

Alpha blockade only

Question 8

In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

Accepted Answer

T4b

Answer

T4a

Answer

T3

Answer

T2

Question 9

What is the first-line intervention for acute symptomatic hydroureter with ureteral obstruction requiring urgent decompression?

Accepted Answer

Endoscopic ureteral stenting

Answer

Antibiotic prophylaxis alone

Answer

Immediate ureterolithotomy

Answer

Urinary alkalization

Question 10

Which of the following hernias has the highest risk of strangulation?

Accepted Answer

Spigelian

Answer

Indirect

Answer

Direct

Answer

Incisional

NEET-PG 2012

Anatomy

Internal Medicine

Pathology

Pediatrics

Pharmacology

Surgery