Internal Medicine
1 questionsPrepyloric or channel ulcer in the stomach is termed as:
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1041: Prepyloric or channel ulcer in the stomach is termed as:
- A. Type 3 (Correct Answer)
- B. Type 1
- C. Type 4
- D. Type 2
Explanation: ***Type 3*** - **Type 3 ulcers** are located in the **prepyloric region** or within the **pyloric channel** of the stomach. - They are often associated with **duodenal ulcers** and are characterized by **normal to high acid secretion**. *Type 1* - **Type 1 ulcers** are typically found in the **lesser curvature of the stomach body**, not the prepyloric region. - These ulcers are usually associated with **low or normal acid secretion** and are often linked to *H. pylori* infection. *Type 2* - **Type 2 ulcers** involve both a **gastric ulcer** (usually in the body) and an **active or healed duodenal ulcer**. - They are associated with **normal to high acid secretion**, but the location is not exclusively prepyloric. *Type 4* - **Type 4 ulcers** are located high on the **lesser curvature near the gastroesophageal junction**. - They are associated with **low acid secretion** and are sometimes termed **juxta-esophageal ulcers**.
Radiology
1 questionsRetrocardiac lucency with air fluid level is seen in
NEET-PG 2013 - Radiology NEET-PG Practice Questions and MCQs
Question 1041: Retrocardiac lucency with air fluid level is seen in
- A. Distal esophageal obstruction
- B. Diaphragmatic eventration
- C. Hiatus hernia (Correct Answer)
- D. None of the options
Explanation: ***Hiatus hernia*** - A **hiatus hernia** occurs when part of the stomach protrudes into the chest through the **esophageal hiatus** of the diaphragm. - This can lead to a **retrocardiac lucency** (gas-filled stomach) with an **air-fluid level** visible on chest X-rays due to gastric contents. - The herniated gastric fundus appears as a characteristic gas bubble behind the heart, particularly well-seen on lateral chest radiographs. *Distal esophageal obstruction* - While distal esophageal obstruction can cause esophageal dilation and sometimes an **air-fluid level** within the esophagus, it generally presents as a tubular structure *behind* the heart rather than a distinct retrocardiac lucency representing a portion of the stomach. - The appearance would be more suggestive of a dilated esophagus filled with contents, not a herniated stomach. *Diaphragmatic eventration* - **Diaphragmatic eventration** is an abnormal elevation of a portion of the diaphragm, often due to congenital weakness or phrenic nerve paralysis. - It does not typically cause a **retrocardiac lucency** with an **air-fluid level**, as it involves the diaphragm itself rather than the herniation of an abdominal organ. - It may show elevation of the hemidiaphragm but without the characteristic gas-filled viscus appearance. *None of the options* - Hiatus hernia is a well-established radiological diagnosis for retrocardiac lucency with an **air-fluid level**, making this option clearly incorrect.
Surgery
8 questionsMay-Thurner or Cockett syndrome involves:
Best prognostic factor for head injury is:
Which of the following is a contraindication to breast conservation surgery?
Sentinel lymph node biopsy in carcinoma breast is done if -
Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?
What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?
Which of the following is a component of the Alvarado score?
The most common cause of acquired AV fistula is:
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 1041: May-Thurner or Cockett syndrome involves:
- A. Left iliac vein compression (Correct Answer)
- B. Internal iliac artery obstruction
- C. Common iliac artery obstruction
- D. Internal iliac vein obstruction
Explanation: ***Correct: Left iliac vein compression*** - May-Thurner syndrome, also known as Cockett syndrome, specifically describes the **compression of the left common iliac vein** by the overlying right common iliac artery. - This anatomical compression can lead to **venous outflow obstruction**, increasing the risk of deep vein thrombosis (DVT) in the left leg. *Incorrect: Internal iliac artery obstruction* - This condition involves an artery and is unrelated to May-Thurner syndrome, which is a **venous compression disorder**. - Obstruction of the internal iliac artery would typically cause symptoms of **pelvic ischemia** or erectile dysfunction, not venous DVT. *Incorrect: Common iliac artery obstruction* - Obstruction of the common iliac artery is an **arterial occlusion** that would cause peripheral artery disease symptoms in the leg, such as claudication or rest pain. - It does not involve the compression of a vein by an artery, which is characteristic of May-Thurner syndrome. *Incorrect: Internal iliac vein obstruction* - While this is a venous issue, May-Thurner syndrome specifically involves the **common iliac vein**, not the internal iliac vein. - Obstruction of the internal iliac vein would typically present with symptoms related to pelvic venous congestion, distinct from the left lower extremity DVT associated with May-Thurner syndrome.
Question 1042: Best prognostic factor for head injury is:
- A. Glasgow coma scale (Correct Answer)
- B. Age
- C. Mode of injury
- D. CT
Explanation: ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.
Question 1043: Which of the following is a contraindication to breast conservation surgery?
- A. Presence of multicentric tumors (Correct Answer)
- B. Involvement of axillary lymph nodes
- C. Tumor size greater than 4 cm
- D. Presence of diffuse microcalcifications
Explanation: ***Presence of multicentric tumors*** - **Multicentric tumors** are defined as two or more discrete tumors in different quadrants of the breast, which cannot be removed with a single lumpectomy. - This condition is a contraindication for breast conservation surgery (BCS) because complete removal of all tumor foci while maintaining an acceptable cosmetic outcome is highly unlikely. *Involvement of axillary lymph nodes* - **Axillary lymph node involvement** is an important prognostic factor in breast cancer and influences adjuvant therapy decisions, but it is not a direct contraindication to BCS. - Patients with positive nodes often undergo axillary dissection or sentinel lymph node biopsy, followed by radiation and/or systemic therapy, which can be combined with BCS. *Tumor size greater than 4 cm* - While larger tumor size (e.g., >4-5 cm) can make achieving negative surgical margins and a good cosmetic outcome more challenging with BCS, it is not an absolute contraindication. - **Neoadjuvant chemotherapy** can often downstage larger tumors, making BCS a viable option for many patients. *Presence of diffuse microcalcifications* - **Diffuse microcalcifications** can sometimes indicate extensive ductal carcinoma in situ (**DCIS**) or invasive lobular carcinoma with a widespread component. - However, if the microcalcifications represent a single focus of disease that can be entirely excised with negative margins, BCS may still be an option, especially if guided by stereotactic biopsy and imaging.
Question 1044: Sentinel lymph node biopsy in carcinoma breast is done if -
- A. LN palpable
- B. Breast lump with palpable axillary node
- C. Metastatic CA breast
- D. Breast mass but no lymph node palpable (Correct Answer)
Explanation: ***Breast mass but no lymph node palpable*** - Sentinel lymph node biopsy is primarily performed in patients with **clinically negative axillae** (no palpable lymph nodes) to assess for microscopic metastatic disease. - The goal is to avoid full axillary lymph node dissection if the sentinel nodes are negative, thus reducing the risk of **lymphedema** and other complications. *LN palpable* - If a lymph node is palpable, it is often considered **clinically suspicious** and may warrant a direct fine-needle aspiration (FNA) or core biopsy rather than a sentinel node biopsy. - A positive biopsy from a palpable node would typically lead directly to an **axillary lymph node dissection** or neoadjuvant therapy, as the sentinel node procedure offers less benefit in this scenario. *Breast lump with palpable axillary node* - Similar to a palpable LN, a **palpable axillary node** in the presence of a breast lump suggests established nodal involvement. - In such cases, **sentinel lymph node biopsy** is often not the initial step; rather, direct biopsy of the palpable node or upfront axillary dissection (sometimes after neoadjuvant treatment) is considered. *Metastatic CA breast* - In **metastatic breast cancer** (stage IV disease), the focus shifts to systemic treatment, and axillary lymph node dissection, including sentinel node biopsy, is generally not indicated for staging purposes. - The primary goal is palliative care or controlling systemic disease, not regional lymph node staging.
Question 1045: Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?
- A. T4 N3 MX
- B. T4 N1 M1
- C. T4 N0 M0
- D. T3 N3c MX (Correct Answer)
Explanation: ***T3 N3c MX*** - A **breast mass of 6 x 3 cm** indicates a T3 tumor (tumor size > 5 cm). - **Ipsilateral supraclavicular lymph node involvement** is classified as N3c disease. **Distant metastasis that cannot be assessed** is denoted by MX. *T4 N3 MX* - A **T4 classification** is reserved for tumors with direct extension to the chest wall or skin, or inflammatory breast cancer, which is not mentioned here. - While N3c and MX are correct for the nodal and metastatic status, the T stage is inaccurate based on the provided tumor size. *T4 N1 M1* - A **T4 classification** is incorrect as the mass size alone (6 x 3 cm) does not meet T4 criteria. - **N1** denotes involvement of 1-3 axillary lymph nodes, which is less extensive than supraclavicular involvement (N3c). **M1** indicates confirmed distant metastasis, but the question states it "cannot be assessed" (MX). *T4 N0 M0* - **T4** is incorrect, as this stage is for direct chest wall/skin involvement or inflammatory breast cancer. - **N0** signifies no regional lymph node metastasis, contradicting the presence of supraclavicular lymph node involvement. **M0** indicates no distant metastasis, whereas the question specifies it cannot be assessed (MX).
Question 1046: What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?
- A. Delorme's procedure
- B. Wells' procedure
- C. Thiersch's operation (Correct Answer)
- D. Low anterior resection
Explanation: ***Thiersch's operation*** - **Thiersch's operation** is a perineal procedure involving the placement of a **circum-anal cerclage** (a non-absorbable suture) around the anal canal to prevent external prolapse. - It is preferred in elderly or frail patients due to its **minimal invasiveness**, low operative risk, and suitability for local or regional anesthesia as a palliative measure for symptoms. *Delorme's procedure* - **Delorme's procedure** is a perineal approach that involves the **mucosal stripping** of the prolapsed rectum, plication of the muscularis, and re-anastomosis. - While less invasive than abdominal approaches, it is more complex than Thiersch's and may still carry higher operative risks for very frail patients. *Wells' procedure* - **Wells' procedure** (rectopexy via an abdominal approach) involves **mobilization of the rectum** and its fixation to the sacrum, often with a mesh. - This is a more invasive abdominal procedure with a higher operative risk, making it unsuitable for elderly patients unfit for major surgery. *Low anterior resection* - **Low anterior resection** is a major abdominal procedure primarily used for rectal cancer or severe inflammatory bowel disease, involving the **surgical removal of a segment of the rectum**. - It is a highly invasive procedure with significant morbidity and mortality, making it inappropriate for the palliative management of rectal prolapse in frail elderly patients.
Question 1047: Which of the following is a component of the Alvarado score?
- A. Leucopenia
- B. Diarrhea
- C. Periumbilical pain
- D. Loss of appetite (Correct Answer)
Explanation: ***Loss of appetite*** - **Anorexia** (loss of appetite) is a key symptom considered in the Alvarado score, contributing 1 point to the total. - This symptom is often one of the **earliest indicators** of acute appendicitis. *Leucopenia* - The Alvarado score uses **leukocytosis** (elevated white blood cell count greater than 10,000/mm³), not leucopenia, as a component. - **Leucopenia** (decreased white blood cell count) is generally not indicative of acute appendicitis. *Diarrhea* - While diarrhea can sometimes accompany appendicitis, it is **not a specific component** of the Alvarado score. - The score focuses on classic appendicitis symptoms like **migratory and right lower quadrant pain**. *Periumbilical pain* - The Alvarado score specifically considers **migratory pain to the right iliac fossa** (RLQ tenderness) as a component, not just periumbilical pain. - Although pain often starts periumbilically, the score emphasizes the **subsequent migration** of pain.
Question 1048: The most common cause of acquired AV fistula is:
- A. Bacterial infection
- B. Fungal infection
- C. Blunt trauma
- D. Penetrating trauma (Correct Answer)
Explanation: ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.