NEET-PG 2012 Practice Questions

Q: Diagnosis of carcinoid tumour is done by urinary estimation of:

5HIAA. ***5HIAA*** - The urinary estimate of **5-hydroxyindoleacetic acid (5HIAA)** is the primary diagnostic test for **carcinoid tumors** [1], particularly those secreting serotonin. - Elevated levels of **5HIAA** in urine indicate excessive serotonin production, which is characteristic of these tumors. *VMA* - **Vanillylmandelic acid (VMA)** is a metabolite of catecholamines and is primarily used in diagnosing **neuroblastoma** or **pheochromocytoma**, not carcinoid tumors. - Although it indicates catecholamine secretion, it does not correlate with **serotonin** levels associated with carcinoid tumors. *Metanephrines* - **Metanephrines** represent metabolites of catecholamines and are mainly evaluated for **pheochromocytoma**. - They do not provide information on serotonin metabolism or carcinoid tumor activity. *Catecholamines* - Catecholamines such as **epinephrine and norepinephrine** are not specifically related to carcinoid tumors and often indicate other neuroendocrine tumors. - Their levels do not correlate with serotonin or its metabolite, **5HIAA**, used for carcinoid diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 12-15.

Q: Richner-Hanhart syndrome is characterized by which of the following?

Ocular and cutaneous features. ***Ocular and cutaneous features*** - **Richner-Hanhart syndrome**, also known as **Tyrosinemia type II**, is characterized by the classic triad of **painful hyperkeratotic plaques** on the palms and soles (cutaneous features), **corneal ulcers** or **dendritic keratitis** (ocular features), and **variable neurological involvement**. - These features arise from the accumulation of **tyrosine** due to a deficiency of the enzyme **hepatic tyrosine aminotransferase (TAT)**. - The **ocular and cutaneous manifestations** are the hallmark features that define this syndrome. *Autosomal dominant* - Richner-Hanhart syndrome is inherited in an **autosomal recessive** pattern, meaning two copies of the defective gene (TAT gene on chromosome 16) are required for the condition to manifest. - An **autosomal dominant** inheritance pattern would mean only one copy of the defective gene is sufficient to cause the disorder. *Associated with abnormality in lipid metabolism* - The syndrome is an inborn error of **amino acid metabolism**, specifically involving **tyrosine**, not lipid metabolism. - Diseases associated with abnormality in **lipid metabolism** include conditions like Gaucher disease, Niemann-Pick disease, or Fabry disease. *Never associated with neurological involvement* - This is **incorrect**. **Neurological involvement** including intellectual disability, developmental delay, seizures, and behavioral problems occurs in **30-50% of cases**. - The accumulation of **tyrosine** and its metabolites (particularly tyrosine crystals) can be **neurotoxic**, leading to varying degrees of neurological impairment. - Early dietary restriction of tyrosine and phenylalanine can prevent or minimize neurological complications.

Q: What is the initial treatment of choice for managing secondary hyperparathyroidism in patients with renal osteodystrophy?

Phosphate binders. ***Phosphate binders*** - **Phosphate binders** are the initial treatment because **hyperphosphatemia** is the primary driver of secondary hyperparathyroidism in renal disease, triggering parathyroid hormone (PTH) release [1]. - They work by binding dietary phosphate in the gastrointestinal tract, preventing its absorption and thus lowering serum phosphate levels [1]. *Cinacalcet* - **Cinacalcet** is a calcimimetic that increases the sensitivity of calcium-sensing receptors on the parathyroid gland, reducing **PTH secretion** [1]. - It is often used if **phosphate binders** and **vitamin D analogs** are insufficient in controlling PTH, making it a second-line treatment [1]. *Bisphosphonates* - **Bisphosphonates** are used to treat osteoporosis by inhibiting osteoclast activity and reducing bone resorption. - They are generally contraindicated in advanced renal osteodystrophy due to concerns about adynamic bone disease and are not an initial treatment for **secondary hyperparathyroidism**. *Calcium restriction* - While restricting dietary calcium might seem intuitive, **hypocalcemia** is often a problem in renal disease due to impaired vitamin D activation [1]. - Overly restricting calcium can worsen hypocalcemia, which would further stimulate PTH release, thus it is not an initial treatment for **secondary hyperparathyroidism**.

Q: In Marfan's syndrome, Aortic aneurysm occurs most commonly in:

Ascending aorta. ***Ascending aorta*** - The **ascending aorta** is the most common site for aortic aneurysm and dissection in Marfan syndrome due to cystic medial degeneration weakening the vessel wall [1]. - This predisposition is linked to defects in the **fibrillin-1 gene (FBN1)**, severely impacting the structural integrity of the arterial media primarily in the ascending aorta [1]. *Descending aorta* - While possible, **descending aortic** involvement is less common than ascending aortic involvement in Marfan syndrome [2]. - Aneurysms here are more frequently associated with atherosclerosis or other connective tissue disorders. *Abdominal aorta* - **Abdominal aortic aneurysms** are relatively rare in Marfan syndrome and are more typically seen in older patients with atherosclerosis [3]. - The disease primarily affects the elastic tissue content, which is most abundant in the proximal aorta. *Arch of aorta* - Aortic arch aneurysms can occur, but they are still less frequent than those in the **ascending aorta** as the primary initial site of dilation and dissection in Marfan syndrome. - Arch involvement often represents an extension of a more proximal ascending aortic pathology.

Q: In which of the following conditions is hypomagnesemia not typically observed?

Diabetes mellitus. Diabetes mellitus - While hypomagnesemia can occur in poorly controlled diabetes due to osmotic diuresis, it is not a typical or defining feature of the condition itself in the same way as other options. - Many individuals with controlled diabetes may have normal magnesium levels, and it's often associated with complications rather than the primary disease process. Diarrhea - Chronic or severe diarrhea leads to significant gastrointestinal losses of electrolytes, including magnesium. - This is a common cause of hypomagnesemia, as the body loses fluids and minerals before they can be absorbed. Gitelman syndrome - This is a renal tubular disorder characterized by a defect in the thiazide-sensitive Na-Cl cotransporter in the distal convoluted tubule. - It leads to hypomagnesemia (due to increased renal excretion) and hypokalemia, along with metabolic alkalosis. Bartter syndrome - This syndrome involves a defect in the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle. - It results in significant renal wasting of magnesium [1], leading to hypomagnesemia, along with hypokalemia and metabolic alkalosis.

Q: A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?

Swyer-James-MacLeod syndrome. ***Swyer-James-MacLeod syndrome*** - This syndrome presents with **unilateral hyperlucent lung**, reduced vascularity, and bronchiectasis, often following a severe childhood respiratory infection, leading to air trapping and recurrent infections. - The imaging findings of **unilateral loss of lung volume**, hyperlucency, and reduced vascularity are classic for Swyer-James-MacLeod syndrome, which is also known as unilateral emphysema. *Immotile cilia syndrome* - This is a broader term that encompasses conditions like Kartagener syndrome, characterized by ciliary dysfunction leading to **recurrent sinopulmonary infections**; however, it does not typically present with unilateral hyperlucent lung or reduced vascularity. - While it causes bronchiectasis, the specific imaging findings described (unilateral hyperlucency) are not characteristic of isolated immotile cilia syndrome. *Kartagener syndrome* - This is a subgroup of primary ciliary dyskinesia that includes the classic triad of **situs inversus**, bronchiectasis, and sinusitis. The patient in the prompt has normally placed abdominal organs, ruling out situs inversus. - Although it involves recurrent pulmonary infections and bronchiectasis, the presence of **normally placed abdominal organs** and unilateral hyperlucency on imaging makes Kartagener syndrome less likely. *Mendelson syndrome* - This refers to **chemical pneumonitis** caused by the aspiration of gastric contents, typically during anesthesia or in patients with impaired consciousness. - It presents acutely with respiratory distress, hypoxemia, and diffuse infiltrates on imaging, which is inconsistent with the chronic presentation of recurrent infections and unilateral hyperlucency described.

Q: What is the drug of choice for listeria meningitis?

Ampicillin. ***Ampicillin*** - **Ampicillin** is the **drug of choice** for *Listeria monocytogenes* meningitis due to its excellent in vitro activity and good central nervous system penetration. - It is often used in combination with an **aminoglycoside** (e.g., gentamicin) for synergistic bactericidal activity, especially in severe cases, though gentamicin does not penetrate the CSF well. *Cefotaxime* - **Third-generation cephalosporins** like cefotaxime have poor activity against *Listeria monocytogenes* due to the organism's intrinsic resistance to these agents. - While effective against many other bacterial causes of meningitis (e.g., *S. pneumoniae*, *N. meningitidis*), it is not appropriate for *Listeria*. *Ceftriaxone* - Similar to cefotaxime, **ceftriaxone** is a third-generation cephalosporin and is **ineffective** against *Listeria monocytogenes* due to the lack of penicillin-binding protein (PBP) affinity. - Its use for *Listeria* meningitis would lead to treatment failure. *Ciprofloxacin* - **Ciprofloxacin**, a fluoroquinolone, is generally **not recommended** as a first-line treatment for *Listeria* meningitis, despite some in vitro activity. - Its use is typically reserved for patients with severe allergies to penicillins, and even then, **trimethoprim-sulfamethoxazole** is usually preferred as an alternative to ampicillin.

Q: The appearance described as an inverted champagne bottle is associated with which condition?

Lipodermatosclerosis. ***Lipodermatosclerosis*** - This condition presents with a characteristic "inverted champagne bottle" appearance, where the **ankle area is narrow** and the **calf area above it is wider** due to fibrotic changes and fat atrophy. - It's a severe manifestation of **chronic venous insufficiency**, characterized by **skin hardening**, pigmentation, and inflammation, often preceding venous ulceration. *Varicose veins (enlarged, twisted veins)* - While associated with **venous insufficiency**, varicose veins themselves are **dilated, tortuous superficial veins**, and do not typically cause the generalized lower leg shape change described. - They may cause swelling and discomfort but do not directly lead to the **fibrotic narrowing** seen in an "inverted champagne bottle" leg. *Deep vein thrombosis (DVT) (acute venous obstruction)* - DVT is an **acute condition** involving a **blood clot in a deep vein**, leading to sudden onset pain, swelling, and redness. - It does not cause the **chronic skin changes** and **fibrotic reshaping** of the calf and ankle that characterize lipodermatosclerosis. *Venous ulceration (open sores due to venous insufficiency)* - Venous ulcers are **open sores** that occur in severe chronic venous insufficiency, often found above the medial malleolus. - While they are a complication of the underlying venous disease that can also cause lipodermatosclerosis, the ulceration itself is a **skin lesion**, not the **overall inverted champagne bottle shape** of the leg.

Q: A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Incision biopsy. ***Incision biopsy*** - An **incision biopsy** is most appropriate for a large tumor (10 cm) to obtain a tissue diagnosis without performing a potentially morbid or disfiguring complete excision upfront. - It involves removing a representative section of the tumor for histopathological analysis, providing adequate tissue for diagnosis, grading, and subtyping. - This allows definitive treatment planning based on confirmed histopathology. *Excision biopsy* - **Excision biopsy** is generally reserved for smaller tumors (typically <3-5 cm) that can be completely resected with acceptable cosmetic and functional outcomes. - Excision of a 10 cm tumor on the thigh would be a significant surgical procedure, potentially causing substantial morbidity, without a prior definitive diagnosis. - Could compromise subsequent definitive surgery if margins are inadequate. *FNAC* - **FNAC (Fine Needle Aspiration Cytology)** provides only cytological diagnosis, which is insufficient for definitive diagnosis, grading, and subtyping of soft tissue tumors, especially sarcomas. - It misses crucial architectural features and tissue patterns needed for accurate classification. - May yield inadequate or non-diagnostic samples from large heterogeneous tumors. *USG* - **USG (Ultrasound)** is an imaging modality, not a tissue diagnosis procedure. - While useful for characterizing mass features (size, location, vascularity, solid vs cystic), it cannot provide histopathological diagnosis. - The question specifically asks for a procedure to "obtain a diagnosis," which requires tissue sampling for microscopic examination.

Q: Which of the following is a common consequence of gastrectomy?

Iron deficiency. ***Iron deficiency*** - Gastrectomy often leads to **achlorhydria** or hypochlorhydria, reducing the conversion of **ferric iron** (Fe3+) to its more absorbable ferrous form (Fe2+). - Additionally, bypassing the duodenum, a primary site of iron absorption, further contributes to **iron malabsorption**. *Calcium deficiency* - While gastrectomy can contribute to calcium malabsorption due to reduced gastric acidity and faster transit, **iron deficiency** is typically a more direct and common initial consequence. - **Vitamin D deficiency**, often co-occurring with gastrectomy, is a more direct cause of **calcium malabsorption**. *Steatorrhoea* - **Steatorrhoea** (fat malabsorption) is more commonly associated with conditions affecting the **pancreas** or **small intestine** (e.g., celiac disease, chronic pancreatitis) rather than primarily gastrectomy unless there is significant bile salt malabsorption or rapid gastric emptying affecting nutrient mixing. - Although rapid transit post-gastrectomy can sometimes impair fat digestion, it's not the most common direct consequence compared to iron deficiency. *Fluid loss* - **Fluid loss** is usually an acute post-surgical complication or related to conditions causing vomiting or diarrhea, and not a common long-term consequence of gastrectomy itself. - While **dumping syndrome** can occur after gastrectomy, causing osmotic fluid shifts into the intestine, generalized chronic fluid loss is not a primary recognized long-term sequela.

Question 1

Diagnosis of carcinoid tumour is done by urinary estimation of:

Accepted Answer

5HIAA

Answer

VMA

Answer

Metanephrines

Answer

Catecholamines

Question 2

Richner-Hanhart syndrome is characterized by which of the following?

Accepted Answer

Ocular and cutaneous features

Answer

Autosomal dominant

Answer

Associated with abnormality in lipid metabolism

Answer

Never associated with neurological involvement

Question 3

What is the initial treatment of choice for managing secondary hyperparathyroidism in patients with renal osteodystrophy?

Accepted Answer

Phosphate binders

Answer

Cinacalcet

Answer

Bisphosphonates

Answer

Calcium restriction

Question 4

In Marfan's syndrome, Aortic aneurysm occurs most commonly in:

Accepted Answer

Ascending aorta

Answer

Descending aorta

Answer

Abdominal aorta

Answer

Arch of aorta

Question 5

In which of the following conditions is hypomagnesemia not typically observed?

Accepted Answer

Diabetes mellitus

Answer

Diarrhea

Answer

Gitelman syndrome

Answer

Bartter syndrome

Question 6

A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?

Accepted Answer

Swyer-James-MacLeod syndrome

Answer

Immotile cilia syndrome

Answer

Kartagener syndrome

Answer

Mendelson syndrome

Question 7

What is the drug of choice for listeria meningitis?

Accepted Answer

Ampicillin

Answer

Cefotaxime

Answer

Ciprofloxacin

Answer

Ceftriaxone

Question 8

The appearance described as an inverted champagne bottle is associated with which condition?

Accepted Answer

Lipodermatosclerosis

Answer

Varicose veins

Answer

Deep vein thrombosis

Answer

Venous ulceration

Question 9

A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Accepted Answer

Incision biopsy

Answer

Excision biopsy

Answer

FNAC

Answer

USG

Question 10

Which of the following is a common consequence of gastrectomy?

Accepted Answer

Iron deficiency

Answer

Calcium deficiency

Answer

Steatorrhoea

Answer

Fluid loss

NEET-PG 2012

Biochemistry

Dermatology

Internal Medicine

Pediatrics

Pharmacology

Surgery