NEET-PG 2013 Practice Questions

Q: Which of the following is not a sign of stellate ganglion block?

Exophthalmos. ***Exophthalmos*** - A stellate ganglion block paralyses the **sympathetic nervous system** to the head and neck. - **Exophthalmos** (bulging of the eye) is a sign of sympathetic **hyperactivity**, not blockade. *Miosis* - **Miosis** (pupil constriction) is a classic sign of sympathetic blockade. - The **dilator pupillae muscle** is paralyzed, leading to unopposed parasympathetic action. *Nasal congestion* - **Nasal congestion** is a common sign due to the **vasodilation** of nasal blood vessels from sympathetic blockade. - Sympathetic nerves normally cause **vasoconstriction** in the nasal mucosa. *Conjunctival redness* - **Conjunctival redness** occurs due to **vasodilation** of conjunctival blood vessels, a direct effect of sympathetic blockade. - This is part of the **Horner's syndrome** presentation.

Q: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Mitral stenosis. ***Mitral stenosis*** - **Mitral stenosis** leads to an obstruction of blood flow from the **left atrium to the left ventricle**, causing pressure buildup in the left atrium [1]. - This increased pressure over time results in **left atrial enlargement** as the chamber struggles to push blood through the narrowed valve [1]. *Tricuspid regurgitation* - **Tricuspid regurgitation** involves the backflow of blood from the **right ventricle to the right atrium**. - This condition primarily affects the **right side of the heart**, leading to **right atrial enlargement**, not left. *AR* - **Aortic regurgitation (AR)** is the backflow of blood from the **aorta into the left ventricle**. - While AR can cause **left ventricular enlargement** and eventually lead to left atrial dilation, it is not the most common direct cause of *primary* left atrial enlargement compared to mitral stenosis [2]. *None of the options* - **Mitral stenosis** is a well-established cause of significant left atrial enlargement due to the direct pressure overload it imposes on the left atrium [1].

Q: In a patient with high clinical suspicion of pulmonary thromboembolism, best investigation would be?

CT angiography. ***CT angiography*** - In a patient with **high clinical suspicion** of pulmonary embolism (PE), CT angiography of the pulmonary arteries is the preferred and often definitive diagnostic test. - It allows for direct visualization of thrombi within the pulmonary arterial tree with high sensitivity and specificity. *D-dimer* - While useful for **ruling out PE** in patients with low or intermediate pre-test probability, a positive D-dimer is non-specific and requires further investigation in high-suspicion cases. - It has a high **negative predictive value** but a low positive predictive value, meaning a normal D-dimer makes PE unlikely, but an elevated one does not confirm it. *Catheter angiography* - This is an **invasive procedure** that is typically reserved for cases where CT angiography is inconclusive or contraindicated, or when interventional treatment is contemplated. - It carries risks such as **bleeding** and **contrast-induced nephropathy**, making it less appropriate as a first-line diagnostic in most situations. *Color Doppler* - Color Doppler ultrasound is primarily used to diagnose **deep vein thrombosis (DVT)** in the lower extremities, which is a common source of PE. - It is **not used to directly diagnose PE** in the pulmonary arteries; however, finding a DVT can support the diagnosis of PE indirectly.

Q: Calcified pulmonary metastasis is seen in which carcinoma?

Thyroid carcinoma. ***Thyroid carcinoma*** - **Papillary** and **medullary thyroid carcinomas** can produce **calcified pulmonary metastases**. - In **papillary thyroid cancer**, calcification occurs due to **psammoma bodies** (concentrically laminated calcified structures). - In **medullary thyroid cancer**, calcification can occur through **dystrophic calcification** within the tumor tissue. - Other common causes of calcified lung metastases include **osteosarcoma** and **chondrosarcoma**. *Pancreatic carcinoma* - Pancreatic carcinoma rarely causes **calcified pulmonary metastases**; metastatic lesions are typically **non-calcified**. - Metastases are more commonly found in the **liver** and **peritoneum**. - Primary pancreatic tumors may show calcification, but metastases usually do not. *Endometrial carcinoma* - Endometrial carcinoma metastases to the lungs are usually **non-calcified** and appear as **soft tissue nodules**. - While it can metastasize to the lungs, **calcification** is not a typical feature of its pulmonary spread. *None of the options* - This option is incorrect because **thyroid carcinoma** (particularly papillary type) is a well-recognized cause of **calcified pulmonary metastases**. - Among epithelial malignancies, thyroid carcinoma is one of the classic causes of this finding.

Q: Which view is best for visualizing the collapse of the middle lobe of the lung?

Lateral. ***Lateral*** - A **lateral chest X-ray** is crucial for localizing abnormalities to specific lung lobes because it allows for a clear visualization of the **fissures** which define the lung lobes. - Collapse of the right middle lobe is particularly well-visualized on a lateral view as a **triangular opacity** that points towards the hilum, often obliterating the right heart border. *Anteroposterior (AP)* - While an AP or PA view can show collapse, it often appears as a **non-specific wedge or triangular opacity** and struggles with precise lobar localization due to superimposed structures. - The **heart shadow and mediastinum** can obscure parts of the middle lobe, making definitive diagnosis challenging from this view alone. *Oblique* - Oblique views are typically used for specific purposes, such as evaluating the **pleura** or **ribs**, and are not a standard view for initial assessment of lobar collapse. - They introduce **distortion and superimposition** that can make the identification and characterization of lobar collapse more difficult than a standard lateral projection. *Lordotic* - A lordotic view is primarily used to visualize the **lung apices** and to differentiate apical lesions from superimposed clavicular shadows. - It is not effective for visualizing the middle lobe, which is located more inferiorly, and would introduce significant distortion, making assessment of its collapse unreliable.

Q: Air bronchogram on chest X-ray denotes -

Intrapulmonary lesion. ***Intrapulmonary lesion*** - An **air bronchogram** indicates that the air-filled bronchi are surrounded by consolidated or fluid-filled alveoli, making the bronchi visible against the opacified lung parenchyma. - This pattern is a strong sign of a process **within the lung tissue itself**, such as pneumonia, pulmonary edema, or malignancy. *Extrapulmonary lesion* - **Extrapulmonary lesions**, such as pleural effusions or masses originating from the chest wall, typically displace or compress the lung and bronchi, rather than filling the alveoli around them. - They usually do **not produce an air bronchogram** because the air in the bronchi is not juxtaposed against diseased lung parenchyma. *Intrathoracic lesion* - This is a broad term that includes all lesions within the thoracic cavity, both intrapulmonary and extrapulmonary. - While an air bronchogram is an intrathoracic finding, it specifically points to an **intrapulmonary process**, not just any intrathoracic lesion. *Extrathoracic lesion* - **Extrathoracic lesions** are located outside the chest cavity and would not manifest as an air bronchogram on a chest X-ray. - This option is **completely unrelated** to the interpretation of an air bronchogram.

Q: Which of the following is NOT a typical differential diagnosis for a solitary pulmonary nodule?

Mycetoma. ***Mycetoma*** - A mycetoma is a **fungal infection** that typically affects subcutaneous tissues, skin, and bone, forming granulomas and sinuses. It is not typically seen as a solitary pulmonary nodule. - While pulmonary fungal infections can occur, a mycetoma in the lung typically presents as a **fungus ball (aspergilloma)** within a pre-existing cavity, rather than a solitary, solid nodule. *Tuberculoma* - A tuberculoma is a **granuloma** caused by Mycobacterium tuberculosis, which can present as a well-defined, solitary pulmonary nodule or mass on imaging. - It represents a contained form of tuberculosis and is a common differential for a solitary pulmonary nodule, especially in endemic areas. *Hamartoma* - A hamartoma is a **benign tumor-like malformation** composed of normal tissues (like cartilage, fat, and muscle) that are disorganized. - It is one of the most common benign causes of a solitary pulmonary nodule. *Bronchogenic carcinoma* - Bronchogenic carcinoma, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, is the most significant concern when evaluating a solitary pulmonary nodule. - It is a primary **malignant lung tumor** and represents a crucial differential diagnosis due to its poor prognosis if not detected and treated early.

Q: What is the most common feature of sarcoidosis on chest X-ray?

Bilateral hilar lymphadenopathy. ***Bilateral hilar lymphadenopathy*** - **Bilateral hilar lymphadenopathy** is the hallmark radiological feature of sarcoidosis, seen in over 75% of cases. - This finding, often symmetrical, represents the accumulation of **non-caseating granulomas** in the lymph nodes. - Classic presentation in **Stage I and Stage II** sarcoidosis. *Pleural effusion* - **Pleural effusions** are uncommon in sarcoidosis, occurring in less than 5% of cases. - When present, they are usually small and unilateral, and their presence should prompt consideration of alternative diagnoses. *Cavitation* - **Cavitation** is a rare manifestation of sarcoidosis and is more characteristic of infectious processes like **tuberculosis** or certain fungal infections. - If seen, it usually suggests severe parenchymal involvement or superimposed infection. *Reticular opacities* - While **reticular opacities** (interstitial changes) can be seen in later stages of sarcoidosis, representing **pulmonary fibrosis**, they are not the *most common* initial finding. - These opacities indicate chronic disease progression (Stage III/IV) rather than the initial presentation.

Q: Which of the following conditions is the MOST COMMON cause of rib notching?

Coarctation of aorta. ***Coarctation of aorta*** - **Coarctation of the aorta** is the classic and **most common cause** of rib notching. - The notching is caused by the enlargement and tortuosity of the **intercostal arteries** as they provide collateral circulation to bypass the narrowed aorta. *Chronic superior venacava obstruction* - Chronic superior vena cava (SVC) obstruction may lead to the development of collateral circulation through the azygos and hemiazygos veins, but it does **not typically cause rib notching**. - Rib notching is specifically related to collateral flow bypassing an aortic obstruction, not a venous obstruction. *Atrial septal defect* - An **atrial septal defect (ASD)** is a communication between the atria that can lead to right heart volume overload and pulmonary hypertension. - While it's a congenital heart defect, an ASD does **not cause rib notching** as it does not involve an obstruction of systemic arterial flow requiring collateral circulation via the intercostal arteries. *Congenital interruption of aorta* - While **congenital interruption of the aorta** also involves an aortic obstruction, it is a **much rarer condition** than coarctation of the aorta. - Due to its rarity, it is not considered the most common cause of rib notching, even though it would theoretically lead to similar collateral vessel formation.

Q: For pericardial calcifications, which is the best investigation?

CT scan. ***Correct: CT scan*** - **CT scans** are highly sensitive and specific for detecting **pericardial calcifications** due to their excellent spatial resolution and ability to measure calcium density (Hounsfield units). - They provide detailed anatomical information about the **pericardium** and can accurately map the extent, location, and thickness of calcified areas. - **CT is the gold standard** for detecting and quantifying pericardial calcification, particularly in constrictive pericarditis. *Incorrect: Ultrasound* - While ultrasound (echocardiography) can visualize the pericardium and may detect calcifications, its ability to definitively identify and characterize **calcifications** is limited compared to CT. - **Acoustic shadowing** from calcifications can obscure underlying structures, making a precise assessment challenging. - Useful for detecting pericardial effusion and thickening, but not optimal for calcification assessment. *Incorrect: MRI* - **MRI excels** in visualizing soft tissues, pericardial inflammation, and fluid collections, but it is **poor at detecting calcium**. - Calcifications typically appear as signal voids (black) on MRI, making it difficult to differentiate them from other structures, air, or motion artifacts. - MRI is valuable for assessing pericardial inflammation and constriction but not the preferred method for calcification. *Incorrect: Transesophageal echocardiography* - TEE offers high-resolution images of cardiac structures and is primarily used for assessing valve function, intracardiac masses, endocarditis, and aortic pathology. - Its utility in detecting and characterizing **pericardial calcifications** is limited compared to CT, especially for diffuse or subtle calcifications. - The pericardium is not optimally visualized with TEE compared to transthoracic echocardiography.

Question 1

Which of the following is not a sign of stellate ganglion block?

Accepted Answer

Exophthalmos

Answer

Miosis

Answer

Conjunctival redness

Answer

Nasal congestion

Question 2

In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Accepted Answer

Mitral stenosis

Answer

Tricuspid regurgitation

Answer

AR

Answer

None of the options

Question 3

In a patient with high clinical suspicion of pulmonary thromboembolism, best investigation would be?

Accepted Answer

CT angiography

Answer

D-dimer

Answer

Catheter angiography

Answer

Color Doppler

Question 4

Calcified pulmonary metastasis is seen in which carcinoma?

Accepted Answer

Thyroid carcinoma

Answer

Pancreatic carcinoma

Answer

Endometrial carcinoma

Answer

None of the options

Question 5

Which view is best for visualizing the collapse of the middle lobe of the lung?

Accepted Answer

Lateral

Answer

Anteroposterior (AP)

Answer

Oblique

Answer

Lordotic

Question 6

Air bronchogram on chest X-ray denotes -

Accepted Answer

Intrapulmonary lesion

Answer

Extrapulmonary lesion

Answer

Intrathoracic lesion

Answer

Extrathoracic lesion

Question 7

Which of the following is NOT a typical differential diagnosis for a solitary pulmonary nodule?

Accepted Answer

Mycetoma

Answer

Tuberculoma

Answer

Hamartoma

Answer

Bronchogenic carcinoma

Question 8

What is the most common feature of sarcoidosis on chest X-ray?

Accepted Answer

Bilateral hilar lymphadenopathy

Answer

Cavitation

Answer

Pleural effusion

Answer

Reticular opacities

Question 9

Which of the following conditions is the MOST COMMON cause of rib notching?

Accepted Answer

Coarctation of aorta

Answer

Atrial septal defect

Answer

Chronic superior venacava obstruction

Answer

Congenital interruption of aorta

Question 10

For pericardial calcifications, which is the best investigation?

Accepted Answer

CT scan

Answer

Ultrasound

Answer

MRI

Answer

Transesophageal echocardiography

NEET-PG 2013

Anesthesiology

Internal Medicine

Pathology

Radiology