Internal Medicine
4 questionsAll of the following are causes of hemobilia, EXCEPT:
In which condition is the Albumin to Globulin (A:G) ratio maintained?
Which of the following is NOT a characteristic feature of systemic sclerosis?
Which of the following is not a treatment option for hypercalcemia?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1101: All of the following are causes of hemobilia, EXCEPT:
- A. Trauma to Abdomen
- B. Hepatitis (Correct Answer)
- C. Rupture of hepatic artery aneurysm
- D. Malignancy
Explanation: ***Hepatitis*** - **Hepatitis** is an inflammation of the liver, typically caused by viral infections, alcohol, or autoimmune processes. While it can lead to liver damage and dysfunction, it does not typically cause **hemobilia**. - **Hemobilia** involves bleeding into the biliary tree, which is usually a result of vascular-biliary fistula formation; hepatitis primarily affects liver parenchymal cells and does not directly result in this type of bleeding. *Trauma to Abdomen* - **Abdominal trauma**, especially liver injuries, can lead to **vascular-biliary fistulae** or direct bleeding into the bile ducts, causing **hemobilia**. - Blunt or penetrating trauma can damage the liver parenchyma and blood vessels, allowing blood to enter the biliary system. *Malignancy* - **Malignant tumors** of the liver or biliary tract (e.g., **cholangiocarcinoma**, **hepatocellular carcinoma**) can erode into blood vessels and bile ducts, leading to **hemobilia**. - The growth of these tumors can rupture fragile vessels within the tumor or adjacent to it, causing blood to leak into the biliary tree. *Rupture of hepatic artery aneurysm* - A ruptured **hepatic artery aneurysm** is a significant and direct cause of **hemobilia**. - The forceful bleeding from the artery can breach the wall of an adjacent bile duct, creating a **fistula** and allowing arterial blood to enter the biliary system.
Question 1102: In which condition is the Albumin to Globulin (A:G) ratio maintained?
- A. Nephritic syndrome (Correct Answer)
- B. Cirrhosis
- C. Protein losing enteropathy
- D. Multiple myeloma
Explanation: ***Nephritic syndrome*** - In nephritic syndrome, the **glomerular filtration is often preserved**, allowing for the maintenance of A:G ratio despite the presence of hematuria and proteinuria [1]. - The condition typically leads to a **moderate degree of proteinuria**, retaining a relatively normal serum albumin level [1]. *Multiple myeloma* - In multiple myeloma, there is often a **high level of paraproteins** leading to a significant drop in albumin, affecting the A:G ratio. - Patients frequently exhibit **renal impairment**, resulting in a disrupted A:G ratio due to increased urinary protein loss. *Protein losing enteropathy* - This condition causes **loss of proteins** like albumin through the gastrointestinal tract, leading to **hypoalbuminemia** and altered A:G ratio. - It is characterized by **diarrhea** and fluid accumulation, further impacting the protein status in circulation. *Cirrhosis* - Cirrhosis leads to **decreased albumin synthesis**, resulting in a low serum albumin and an altered A:G ratio. - The condition is associated with **portal hypertension** and ascites, complicating the biochemical status.
Question 1103: Which of the following is NOT a characteristic feature of systemic sclerosis?
- A. Calcinosis cutis
- B. Digital ulcers
- C. Acroosteolysis
- D. Gottron's papules (Correct Answer)
Explanation: ***Gottron's papules*** - **Gottron's papules** are pathognomonic for **dermatomyositis**, not systemic sclerosis. They are red, scaling papules found over the extensor surfaces of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. - While both systemic sclerosis and dermatomyositis are connective tissue diseases, their distinct cutaneous manifestations aid in differentiation. *Acroosteolysis* - **Acroosteolysis** refers to the resorption of the distal phalanges, a common feature in systemic sclerosis, particularly in severe cases. - This symptom contributes to the characteristic digital abnormalities seen in the disease. *Calcinosis cutis* - **Calcinosis cutis** is the deposition of calcium in the skin and subcutaneous tissues, often seen in subsets of systemic sclerosis, especially the CREST syndrome. - It can manifest as firm, white-yellow nodules or plaques and contribute to skin breakdown. *Digital ulcers* - **Digital ulcers** are a frequent and debilitating complication of systemic sclerosis, resulting from severe **vasculopathy** [1] and **ischemia** [1]. - They are often painful and can lead to significant tissue loss and infection.
Question 1104: Which of the following is not a treatment option for hypercalcemia?
- A. Strontium (Correct Answer)
- B. Bisphosphonates
- C. Steroids
- D. Phosphate
Explanation: ***Strontium*** - **Strontium ranelate** is primarily used in the treatment of **osteoporosis** to promote bone formation and inhibit bone resorption. - It does not have a recognized role in the acute or long-term management of **hypercalcemia** and could potentially worsen it due to its bone-targeting effects if not carefully managed. *Steroids* - **Glucocorticoids** are effective in treating hypercalcemia associated with **granulomatous diseases** (e.g., sarcoidosis) and certain malignancies (e.g., multiple myeloma) by reducing calcitriol production or tumor burden. - They decrease intestinal calcium absorption and increase renal calcium excretion in conditions where 1,25-dihydroxyvitamin D is elevated. *Bisphosphonates* - **Bisphosphonates** (e.g., zoledronic acid, pamidronate) are potent inhibitors of **osteoclast-mediated bone resorption** and are a cornerstone in the treatment of moderate to severe hypercalcemia, especially due to malignancy. [1] - They are administered intravenously and act by inducing osteoclast apoptosis, thereby reducing the release of calcium from bone. [1] *Phosphate* - **Intravenous phosphate** can be used in severe, resistant hypercalcemia, as it promotes calcium deposition into bone and soft tissues, and forms insoluble calcium-phosphate complexes, thus lowering serum calcium. - Its use is limited due to risks of **ectopic calcification**, renal failure, and hypotension, and it is usually reserved for life-threatening situations where other treatments have failed.
Pediatrics
1 questionsAt what age can children typically draw a square?
NEET-PG 2013 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1101: At what age can children typically draw a square?
- A. 5 years (Correct Answer)
- B. 3 years
- C. 6 years
- D. 7 years
Explanation: ***5 years*** - At 5 years old, children have developed the **fine motor skills** and **cognitive abilities** necessary to copy and draw a square independently. - This is a key developmental milestone reflecting improved **visual-motor coordination** and understanding of geometric shapes with corners and angles. - By this age, children can also draw recognizable human figures with multiple body parts. *3 years* - While 3-year-olds can copy a circle and draw vertical/horizontal lines, they typically lack the **fine motor precision** and spatial understanding to draw a square with four equal sides and right angles. - Their drawings of angular shapes are crude approximations or scribbles rather than recognizable squares. *6 years* - By 6 years of age, children are proficient at drawing squares and other basic shapes, and are beginning to draw more complex figures with **perspective** and greater detail. - This age represents refinement beyond the initial mastery of drawing a square, which typically occurs at 5 years. *7 years* - At 7 years old, children have long mastered drawing basic shapes like squares and are capable of drawing objects with **depth and perspective** using multiple shapes, lines, and colors. - They demonstrate more advanced artistic expression and detailed representations.
Pharmacology
1 questionsXDR-TB is defined as resistance to which of the following drug combinations?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 1101: XDR-TB is defined as resistance to which of the following drug combinations?
- A. INH plus rifampicin
- B. Fluoroquinolones plus INH plus amikacin
- C. Fluoroquinolones plus rifampicin plus kanamycin
- D. Fluoroquinolones plus INH plus rifampicin plus amikacin (Correct Answer)
Explanation: **Fluoroquinolones plus INH plus rifampicin plus amikacin** - **Extensively drug-resistant tuberculosis (XDR-TB)** is defined by resistance to the most effective anti-TB drugs: **isoniazid (INH)**, **rifampicin**, any **fluoroquinolone**, and at least one of the three injectable second-line drugs (**amikacin**, **kanamycin**, or **capreomycin**). - This combination signifies a substantial therapeutic challenge due to limited treatment options and a high risk of treatment failure. *INH plus rifampicin* - Resistance to **INH** and **rifampicin** defines **multidrug-resistant tuberculosis (MDR-TB)**, which is a precursor to XDR-TB but not XDR-TB itself. - While serious, MDR-TB is not as extensively resistant as XDR-TB, as it doesn't include resistance to fluoroquinolones and second-line injectables. *Fluoroquinolones plus INH plus amikacin* - This combination is incomplete for the definition of XDR-TB because it omits **rifampicin** from the core definition. - XDR-TB specifically requires resistance to both **INH** and **rifampicin** (defining MDR-TB), in addition to resistance to a fluoroquinolone and one of the injectable second-line drugs. *Fluoroquinolones plus rifampicin plus kanamycin* - This combination is also incomplete for the definition of XDR-TB as it omits **isoniazid (INH)**, which is one of the two most crucial first-line drugs that characterize MDR-TB. - XDR-TB builds upon MDR-TB's resistance to both INH and rifampicin.
Surgery
4 questionsCommonest site of carcinoma tongue -
In which of the following conditions is ERCP not indicated?
A 55-year-old male presents with a history of dysphagia with vomiting of undigested food throughout the day, weight loss, and appears emaciated and dehydrated. No mass is palpable per abdomen. After appropriate diagnostic workup reveals a benign esophageal stricture, the most appropriate definitive management is:
Most common site for anal fissure is
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 1101: Commonest site of carcinoma tongue -
- A. Apical
- B. Lateral borders (Correct Answer)
- C. Dorsum
- D. Posterior 1/3
Explanation: ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.
Question 1102: In which of the following conditions is ERCP not indicated?
- A. Distal CBD tumor
- B. Hepatic porta tumor
- C. Proximal cholangiocarcinoma (Correct Answer)
- D. Gall stone pancreatitis
Explanation: ***Proximal cholangiocarcinoma*** - For **proximal/hilar cholangiocarcinoma** (Klatskin tumors at the **hepatic hilum**), **PTBD (Percutaneous Transhepatic Biliary Drainage)** is generally preferred over ERCP for biliary drainage. - The **high location** of these tumors makes endoscopic access difficult, with lower success rates and higher risk of complications like **cholangitis** and incomplete drainage. - **ERCP may fail** to adequately drain both hepatic ducts in bifurcation tumors, making PTBD the more reliable first-line approach. *Hepatic porta tumor* - **Hepatic porta tumors** involving the bile ducts are anatomically similar to **proximal cholangiocarcinoma**. - While ERCP can occasionally be attempted for porta hepatis lesions, **PTBD is often preferred** for high biliary obstructions due to better access to intrahepatic ducts. - The distinction is subtle, but **proximal cholangiocarcinoma** specifically refers to Klatskin tumors where ERCP has the **highest failure rate** and PTBD is most strongly preferred. *Distal CBD tumor* - **ERCP is the preferred modality** for **distal CBD tumors** to provide **biliary drainage**, tissue sampling (biopsy), and stent placement to relieve obstruction. - Direct endoscopic access to the distal common bile duct makes ERCP highly effective for diagnosis and palliation in this region. *Gallstone pancreatitis* - **ERCP is indicated** in **gallstone pancreatitis** when there is evidence of **cholangitis** or persistent **biliary obstruction** (e.g., rising liver enzymes, imaging showing retained stone in the CBD). - It allows for **therapeutic removal of impacted stones** from the common bile duct, preventing further pancreatic inflammation and complications.
Question 1103: A 55-year-old male presents with a history of dysphagia with vomiting of undigested food throughout the day, weight loss, and appears emaciated and dehydrated. No mass is palpable per abdomen. After appropriate diagnostic workup reveals a benign esophageal stricture, the most appropriate definitive management is:
- A. IV normal saline
- B. pH monitoring
- C. IV total parenteral nutrition
- D. Endoscopic dilation (Correct Answer)
Explanation: ***Endoscopic dilation (preferred treatment)*** - **Endoscopic dilation** directly addresses the underlying problem of the **benign esophageal stricture** by widening the narrowed esophagus, which is crucial for relieving dysphagia and improving nutritional intake. - Given the patient's severe symptoms like **weight loss**, **emaciation**, and **dehydration**, dilation allows for symptom relief and subsequent rehydration and nutritional support. *IV total parenteral nutrition* - While TPN provides nutrition, it does not resolve the **mechanical obstruction** caused by the stricture and carries risks such as infection and metabolic complications. - It's typically reserved for situations where enteral feeding is not possible or adequate after addressing the obstruction. *IV normal saline* - **IV normal saline** would help address the immediate **dehydration**, but it does not treat the underlying cause of the patient's symptoms (the esophageal stricture). - This is a supportive measure, not the primary management strategy for the stricture itself. *pH monitoring* - **pH monitoring** is used to diagnose and assess gastroesophageal reflux disease (**GERD**), which can sometimes cause strictures. - However, in a patient with a confirmed benign esophageal stricture and severe obstructive symptoms, addressing the stricture mechanically (dilation) takes precedence over diagnostic testing for reflux.
Question 1104: Most common site for anal fissure is
- A. 3 O'clock
- B. 6 O'clock (Correct Answer)
- C. 2 O'clock
- D. 10 O'clock
Explanation: ***6 O'clock*** - The **posterior midline (6 o'clock position)** is the most common site for anal fissures, accounting for approximately **90% of all cases**. - This location is prone to tearing due to relatively **poor blood supply** and increased **mechanical stress** during defecation. - The posterior midline is the least supported part of the anal canal by the external anal sphincter. - **Note**: The **anterior midline (12 o'clock position)** is the second most common site, occurring in **10-25% of women** but rarely in men. *3 O'clock* - The **3 o'clock position (right lateral)** is an infrequent site for anal fissures. - Fissures in this location, especially if *lateral*, may suggest an underlying systemic disease such as **Crohn's disease**, **tuberculosis**, **HIV**, or **malignancy**. - Atypical fissures warrant thorough investigation. *2 O'clock* - The **2 o'clock position (anterior-lateral)** is not typically associated with anal fissures. - Similar to other atypical sites, a fissure here warrants investigation for secondary causes. - Consider inflammatory bowel disease or other pathological conditions. *10 O'clock* - The **10 o'clock position (left lateral)** is also a less common site for anal fissures compared to the posterior midline. - Fissures in lateral positions should raise suspicion for other conditions, such as **inflammatory bowel disease**, **tuberculosis**, **HIV**, or **malignancy**.