NEET-PG 2012 Practice Questions

Q: What is the first symptom of leprosy?

Decreased pain. Decreased pain - Leprosy primarily targets Schwann cells in peripheral nerves, leading to sensory loss [1]. - The sensation of pain is typically affected earliest, often presenting as areas of numbness [1]. Decreased vibration & position sense - These sensations are typically carried by larger myelinated fibers, which tend to be affected later in the disease progression of leprosy. - While eventually involved, they are not usually the first symptom of sensory loss. Decreased temperature - Temperature sensation is also an early modality affected in leprosy, as it's carried by small, unmyelinated or thinly myelinated fibers [1]. - However, pain is often cited as the very first sensory loss, even preceding temperature changes in some cases. Decreased light touch - Light touch sensation is generally an early loss, similar to pain and temperature, due to damage to nerve fibers in the skin. - But, when distinguishing the absolute first symptom, pain perception often shows impairment even before light touch in affected areas.

Q: Which of the following pairs of conditions is incorrectly matched?

Erythema chronicum migrans - malignancy. ***Erythema chronicum migrans - malignancy*** - **Erythema chronicum migrans** is the characteristic skin lesion of **Lyme disease**, caused by the bacterium *Borrelia burgdorferi*, transmitted by ticks. - It is not associated with malignancy; rather, its presence indicates a **bacterial infection** requiring antibiotic treatment. *Erythema marginatum - rheumatic fever* - **Erythema marginatum** is a **major diagnostic criterion** for **rheumatic fever**, a post-streptococcal inflammatory disease. - The rash is characterized by non-itchy, pink or red macules with raised, serpiginous borders that spread outwards, often transient. *Erythema gyratum repens - malignancy* - **Erythema gyratum repens** is a rare **paraneoplastic dermatosis** strongly associated with various internal malignancies, most commonly lung cancer. - It presents as a characteristic **wood-grain-like pattern** of concentric, migratory erythematous bands. *Necrotic acral erythema - HCV* - **Necrotic acral erythema** is a skin condition that predominantly affects the hands and feet and has a strong association with **hepatitis C virus (HCV) infection**. - It presents with violaceous plaques that can ulcerate and become necrotic, often in patients with chronic HCV.

Q: Migraine is due to

Cortical spreading depression. ***Cortical spreading depression*** - The current understanding is that **cortical spreading depression (CSD)** is the initiating event in migraine with aura, characterized by a wave of neuronal and glial depolarization that spreads across the cerebral cortex, leading to a temporary shutdown of neuronal activity [1]. - CSD is thought to activate the **trigeminal nerve**, subsequently causing the release of inflammatory neuropeptides and contributing to the pain phase [1]. *Dilatation of cranial blood vessels* - While **vasodilation of intracranial and extracranial blood vessels** does occur during the headache phase of migraine, it is now considered a *consequence* of the initial neurological events rather than the primary cause [1]. - This vasodilation contributes to the throbbing sensation of migraine pain but does not explain the aura or the initiation of the attack. *Constriction of cranial blood vessels* - **Vasoconstriction** was previously thought to be the cause of the migraine aura, but this theory has largely been disproven. - While some temporary constriction may precede CSD, it is not the primary mechanism behind the migraine attack. *Inflammation of the meninges* - While **neurogenic inflammation** of the meninges, involving the release of inflammatory mediators like **calcitonin gene-related peptide (CGRP)**, does play a role in sensitizing the trigeminal system and contributing to migraine pain, it is a downstream effect. - It is not the initial trigger for a migraine attack but rather part of the pain pathway activated by events like CSD.

Q: Which of the following is a characteristic feature of primary Sjogren's syndrome?

Enlargement of salivary glands. ***Enlargement of salivary glands*** - **Sjögren's syndrome** is characterized by chronic inflammation of **exocrine glands**, leading to swelling and dysfunction, most notably in the **parotid** and **submandibular glands**. - This glandular enlargement often presents as recurrent or persistent **bilateral swelling** of the major salivary glands. *Can occur in children* - While possible, Sjögren's syndrome is predominantly a disease of **adults**, with incidence peaking in individuals between **40 and 60 years old**. - **Juvenile Sjögren's syndrome** is rare and typically presents with more variable symptoms, making it less of a characteristic feature of the primary disease in the general population. *Increased complement C4 is associated with thymoma* - **Increased complement C4** levels are generally not associated with Sjögren's syndrome; instead, **hypocomplementemia** (low C4) can be seen in some patients, indicating immune complex activity. - **Thymoma** is primarily linked to **myasthenia gravis** and other paraneoplastic syndromes, not a direct or characteristic association with Sjögren's syndrome or C4 levels in this context. *Can be associated with rheumatoid arthritis* - Sjögren's syndrome can be classified as **primary** (occurring alone) or **secondary** (occurring in conjunction with another autoimmune disease). - Its association with **rheumatoid arthritis** defines **secondary Sjögren's syndrome**, meaning it's not a characteristic feature of the *primary* form of the disease itself.

Q: The most classical symptom of VIPOMA is:

Secretory diarrhea. The original text cannot be accurately enriched with the provided references to because none of the source materials directly address the pathophysiology or clinical presentation of VIPoma. The available references focus on general gastroenteropancreatic neuroendocrine tumors (NETs) , radiation-induced intestinal damage , arsenic poisoning , gastrointestinal bleeding , and the physiology of taste , but they do not provide the specific confirmation needed for the 'classical symptom' of VIPoma (secretory diarrhea).

Q: Spigelian hernia is

Through lateral border of rectus abdominis. ***Through lateral border of rectus abdominis*** - A **Spigelian hernia** protrudes through the **Spigelian aponeurosis**, which is the aponeurosis of the transversus abdominis muscle, primarily located along the **lateral border of the rectus abdominis muscle**. - Its typical location is often at the **semilunar line**, making it a challenging diagnosis due to its intermittent presentation and potential for strangulation. *Through linea alba* - A hernia through the **linea alba** (midline fibrous structure) is known as an **epigastric hernia** if above the umbilicus, or an **umbilical hernia** if at the umbilicus. - These are distinct from Spigelian hernias which are lateral to the rectus sheath. *Through lateral wall of inguinal canal* - This description typically refers to an **indirect inguinal hernia**, where the contents pass through the **deep inguinal ring**. - This type of hernia travels through the entire inguinal canal and emerges through the superficial ring. *Through medial wall of inguinal canal* - This would describe a **direct inguinal hernia**, which protrudes directly through the posterior wall of the inguinal canal, specifically through **Hesselbach's triangle**. - This is medial to the inferior epigastric vessels, while Spigelian hernias are more superior and lateral.

Q: Ogilvie's syndrome most commonly involves

Cecum and right hemicolon. ***Cecum and right hemicolon*** - Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, primarily affects the **large bowel**. - It most commonly presents with significant dilation of the **cecum and right hemicolon** due to impaired autonomic innervation *Stomach* - The stomach is not typically involved in Ogilvie's syndrome. Conditions affecting the stomach might include **gastroparesis** or **pyloric obstruction**, which have different pathophysiologies. - Ogilvie's syndrome is a disorder of **colonic motility**, not gastric motility. *Gallbladder* - The gallbladder is an organ of the **biliary system** and is not directly affected by Ogilvie's syndrome. - Conditions like **cholecystitis** or **cholelithiasis** involve the gallbladder but are unrelated to acute colonic pseudo-obstruction. *Small intestine* - While pseudo-obstruction can sometimes affect the small intestine (chronic intestinal pseudo-obstruction), Ogilvie's syndrome specifically refers to **acute colonic pseudo-obstruction**. - **Small bowel obstruction** caused by mechanical blockages is a distinct condition with different diagnostic features and management.

Q: A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?

Wound dehiscence. ***Wound dehiscence*** - This is the most likely diagnosis given the presentation of **serous discharge** and a **gap in the wound** on the 5th postoperative day. - **Abdominal intestinal perforation** surgery is a risk factor, and the timing is consistent with **fascial dehiscence**, which can lead to evisceration if left untreated. *Enterocutaneous fistula* - This involves a connection between the **bowel lumen** and the **skin surface**, typically discharging enteric contents (e.g., bile, stool), not just serous fluid. - While a possibility in complicated abdominal surgeries, the description of a "gap in the wound" and serous discharge is more indicative of a **structural failure** of the wound. *Seroma* - A seroma is a collection of **serous fluid** under the skin flap or surgical incision, presenting as a **fluctuant swelling**, but it typically does not involve a "gap in the wound." - It would not usually present with a wound **disruption** that exposes underlying tissue; instead, it's an intact pocket of fluid. *Peritonitis* - This is an **inflammation of the peritoneum**, usually caused by infection, and presents with **severe abdominal pain**, fever, and diffuse tenderness, which are not mentioned here. - While an intestinal perforation would initially cause peritonitis, the current presentation focuses on the **wound site** rather than systemic or diffuse abdominal symptoms.

Q: Which of the following statements about keloids is true?

Local recurrence is common after excision.. ***Local recurrence is common after excision*** - Keloids are characterized by an overgrowth of **scar tissue** that extends beyond the original wound boundaries. - Due to their aggressive fibrous nature and growth factors, **surgical excision alone often leads to recurrence**, sometimes even larger than the original keloid [1]. *They undergo malignant transformation frequently* - Keloids are **benign fibrous growths** and do **not typically undergo malignant transformation**. - While they can be cosmetically distressing and cause symptoms like itching or pain, they are not a precursor to cancer. *They occur equally across all ethnic groups* - Keloids show a significant **predisposition in individuals with darker skin pigmentation**, including those of African, Asian, and Hispanic descent [1]. - This suggests a **genetic component** influencing their occurrence, which is not equally distributed across all ethnic groups [1]. *They remain confined to the original wound boundaries* - This statement describes **hypertrophic scars**, not keloids. - Keloids are specifically defined by their tendency to **grow beyond the margins** of the original injury, invading surrounding healthy skin [1].

Question 1

What is the first symptom of leprosy?

Accepted Answer

Decreased pain

Answer

Decreased vibration & position sense

Answer

Decreased temperature

Answer

Decreased light touch

Question 2

Which of the following pairs of conditions is incorrectly matched?

Accepted Answer

Erythema chronicum migrans - malignancy

Answer

Erythema gyratum repens - malignancy

Answer

Erythema marginatum - rheumatic fever

Answer

Necrotic acral erythema - HCV

Question 3

Migraine is due to

Accepted Answer

Cortical spreading depression

Answer

Dilatation of cranial blood vessels

Answer

Constriction of cranial blood vessels

Answer

Inflammation of the meninges

Question 4

Which of the following is a characteristic feature of primary Sjogren's syndrome?

Accepted Answer

Enlargement of salivary glands

Answer

Can occur in children

Answer

Increased complement C4 is associated with thymoma

Answer

Can be associated with rheumatoid arthritis

Question 5

The most classical symptom of VIPOMA is:

Accepted Answer

Secretory diarrhea

Answer

Gall stones

Answer

Steatorrhea

Answer

Flushing

Question 6

All the following are true about multiple myeloma except for which of the following?

Accepted Answer

Chromosomal translocation t(8;14), commonly seen in Burkitt's lymphoma

Answer

Hypercalcemia

Answer

Presence of Bence-Jones proteins in urine

Answer

Osteolytic bone disease

Question 7

Spigelian hernia is

Accepted Answer

Through lateral border of rectus abdominis

Answer

Through linea alba

Answer

Through lateral wall of inguinal canal

Answer

Through medial wall of inguinal canal

Question 8

Ogilvie's syndrome most commonly involves

Accepted Answer

Cecum and right hemicolon

Answer

Stomach

Answer

Gallbladder

Answer

Small intestine

Question 9

A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?

Accepted Answer

Wound dehiscence

Answer

Enterocutaneous fistula

Answer

Peritonitis

Answer

Seroma

Question 10

Which of the following statements about keloids is true?

Accepted Answer

Local recurrence is common after excision.

Answer

They undergo malignant transformation frequently.

Answer

They occur equally across all ethnic groups.

Answer

They remain confined to the original wound boundaries.

NEET-PG 2012

Dermatology

Internal Medicine

Pathology

Surgery