Internal Medicine
2 questionsA patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is
Which of the following is true about menetrier's disease
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1271: A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is
- A. Endoscopy
- B. Endoscopic ultrasound
- C. Manometry (Correct Answer)
- D. PET CT
Explanation: ***Manometry*** - **Esophageal manometry** measures the pressure and coordination of muscle contractions in the esophagus, which is crucial for diagnosing motility disorders like **achalasia** [1] or **esophageal spasm** [2] that can cause difficulty swallowing liquids. - The symptom of difficulty swallowing liquids but not solids (**paradoxical dysphagia**) is characteristic of a primary esophageal motility disorder rather than a structural obstruction [1]. *Endoscopy* - **Endoscopy** is primarily used to visualize the esophagus and stomach for structural abnormalities such as **strictures**, **tumors**, or **inflammation** [1]. - While it can rule out structural causes, it is less effective for diagnosing purely functional or motility disorders [1]. *Endoscopic ultrasound* - **Endoscopic ultrasound (EUS)** provides detailed imaging of the esophageal wall and surrounding structures, helping to stage cancers or identify extrinsic compression. - It is not the primary investigation for assessing **esophageal motility**. *PET CT* - **PET CT** is primarily used in oncology for **cancer staging**, recurrence detection, and assessing metabolic activity of lesions. - It has limited utility in the initial diagnosis of a **swallowing disorder**, especially one indicating a motility issue.
Question 1272: Which of the following is true about menetrier's disease
- A. Atrophied mucosal folds are seen
- B. It is premalignant condition
- C. There is decreased gastric acid secretion (Correct Answer)
- D. It causes increased gastric acid secretion
Explanation: ***It is a premalignant condition*** - Menetrier's disease is characterized by **hyperplastic gastric mucosa** and is considered a **premalignant condition** due to its association with gastric cancers. - Regular surveillance and monitoring are recommended because of this increased risk for malignancy. *Affects the stomach and small intestines* - Menetrier's disease primarily **affects the stomach**, specifically leading to excessive growth of the gastric mucosa. - It does not typically involve the **small intestines**, which differentiates it from other gastrointestinal diseases. *There is increased gastric acid secretion* - In Menetrier's disease, there is actually a **decreased gastric acid secretion** due to the alteration of gastric mucosal structure. - This condition leads to **hypochlorhydria**, contrasting with conditions that increase acid secretion like Zollinger-Ellison syndrome. *Atrophied mucosal folds are seen* - Menetrier's disease is marked by **hypertrophy of the gastric folds**, not atrophy, resulting in **enlarged rugae** within the stomach. - Atrophied mucosal folds are more associated with conditions like chronic atrophic gastritis.
Obstetrics and Gynecology
1 questionsWhat is the primary hormonal cause of hot flushes experienced during menopause?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1271: What is the primary hormonal cause of hot flushes experienced during menopause?
- A. Increased noradrenaline with normal estrogen levels
- B. Increased noradrenaline
- C. Decreased estrogen levels (Correct Answer)
- D. Both increased noradrenaline and decreased estrogen levels
Explanation: ***Decreased estrogen levels*** - **Decreased estrogen** is the primary hormonal change during menopause, leading to thermoregulatory dysfunction in the hypothalamus. - This hormonal imbalance causes the **vasomotor symptoms** like hot flushes and night sweats. *Increased noradrenaline* - While **noradrenaline** (norepinephrine) is involved in thermoregulation, its increase is a **secondary event** triggered by the initial estrogen deficiency, not the primary cause. - Increased noradrenaline can exacerbate the **vasodilation** and heat dissipation experienced during a hot flush. *Increased noradrenaline with normal estrogen levels* - This option is incorrect because hot flushes are characteristic of menopause, which is defined by **decreased estrogen levels**. - **Normal estrogen levels** would typically prevent the severe thermoregulatory instability that causes hot flushes. *Both increased noradrenaline and decreased estrogen levels* - Although both factors are involved, the question asks for the **primary hormonal cause**. **Decreased estrogen** initiates the cascade of events, including the subsequent alteration of neurotransmitter levels like noradrenaline. - Noradrenaline's role is more of a **mediator** in the physiological response to the primary estrogen deficiency.
Orthopaedics
1 questionsWhich of the following statements is true regarding a Monteggia fracture?
NEET-PG 2015 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 1271: Which of the following statements is true regarding a Monteggia fracture?
- A. Upper ulnar fracture with dislocated radial head. (Correct Answer)
- B. Upper radial fracture with dislocated ulna.
- C. Lower radial fracture with dislocated ulna.
- D. Lower ulnar fracture with dislocated radius.
Explanation: ***Upper ulnar fracture with dislocated radial head.*** - A Monteggia fracture is classically defined as a fracture of the **proximal or middle third of the ulna** accompanied by an **anterior dislocation of the radial head**. - This injury pattern disrupts the alignment of the **forearm bones** and the **elbow joint**, requiring careful reduction and stabilization. *Upper radial fracture with dislocated ulna.* - This statement incorrectly identifies the fractured bone as the radius and the dislocated bone as the ulna. - The defining characteristic of a Monteggia fracture is the **ulnar fracture** and **radial head dislocation**. *Lower radial fracture with dislocated ulna.* - This describes a different type of injury, such as a **Galeazzi fracture**, which involves a **radial shaft fracture** with dislocation of the **distal radioulnar joint**. - It does not fit the criteria for a Monteggia fracture pattern. *Lower ulnar fracture with dislocated radius.* - This description is not consistent with a Monteggia fracture, which specifically involves the **proximal ulna** and **radial head dislocation**. - A lower ulnar fracture with distal radius dislocation is a distinct injury pattern.
Pathology
1 questionsWhich is the most common type of male breast cancer?
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 1271: Which is the most common type of male breast cancer?
- A. Inflammatory Breast Cancer
- B. Invasive Ductal Carcinoma (Correct Answer)
- C. Invasive Lobular Carcinoma
- D. Mucinous Carcinoma
Explanation: ***Invasive Ductal Carcinoma*** - This is by far the most common type of breast cancer in men, accounting for approximately **80-90%** of all male breast cancer cases. - It originates in the **milk ducts** and then invades the surrounding breast tissue. *Invasive Lobular Carcinoma* - This type of cancer originates in the **milk-producing glands (lobules)**. - It is **extremely rare** in men due to the underdeveloped and non-functional lobules in the male breast. *Mucinous Carcinoma* - This is a **rare subtype** of invasive ductal carcinoma characterized by cancer cells that produce **mucin**. - It accounts for only a small percentage of male breast cancers, typically **2-3%** of cases. *Inflammatory Breast Cancer* - This is a **rare and aggressive** form of breast cancer characterized by rapid onset of redness, swelling, and warmth in the breast, often mistaken for an infection. - Although it can occur in men, it is not the most common type and represents a very small fraction of male breast cancer diagnoses.
Physiology
1 questionsLocking of the knee involves which of the following?
NEET-PG 2015 - Physiology NEET-PG Practice Questions and MCQs
Question 1271: Locking of the knee involves which of the following?
- A. Internal rotation of the tibia with the foot on the ground
- B. Contraction of the popliteus muscle
- C. Internal rotation of the femur with the foot on the ground (Correct Answer)
- D. External rotation of femur with the foot off the ground
Explanation: ***Internal rotation of the femur with the foot on the ground*** - When the foot is on the ground (closed kinematic chain), the **femur rotates internally on the tibia** during the end stages of knee extension. This creates a more stable, "locked" position of the knee. - This **terminal rotation of the femur** increases the contact area and tension in the cruciate ligaments, enhancing joint stability for weight-bearing. *Internal rotation of the tibia with the foot on the ground* - This describes the action of the **popliteus muscle** when "unlocking" the knee from full extension, not the locking mechanism itself. - With the foot on the ground, the tibia is fixed, and internal rotation would typically be a movement for unlocking, not locking. *Contraction of the popliteus muscle* - The **popliteus muscle** is primarily responsible for **unlocking the knee** from full extension, by causing internal rotation of the tibia (or external rotation of the femur). - Its contraction would lead to initial flexion of the knee, releasing the locked position, not establishing it. *External rotation of femur with the foot off the ground* - With the foot off the ground (open kinematic chain), **external rotation of the tibia** occurs during the final degrees of extension to lock the knee, not external rotation of the femur. - The locking mechanism requires specific relative rotation between femur and tibia; external rotation of the femur alone would not achieve the screw-home mechanism necessary for knee locking.
Surgery
4 questionsWhich of the following is resected in Whipple's operation, except?
CA Breast may locally spread to all of the following muscles except
A 45-year-old female underwent a modified radical mastectomy with axillary clearance for breast cancer. Post-surgery, she is unable to lift her arm above her head. Which nerve is most likely to be injured?
A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is
NEET-PG 2015 - Surgery NEET-PG Practice Questions and MCQs
Question 1271: Which of the following is resected in Whipple's operation, except?
- A. Duodenum
- B. Head of pancreas
- C. Neck of pancreas (Correct Answer)
- D. Common bile duct
Explanation: ***Neck of pancreas*** - In a **Whipple procedure** (pancreaticoduodenectomy), the **neck of the pancreas** is the site of transection (division), not resection. - The **head of the pancreas** (distal to the neck) is removed, while the **body and tail** (proximal to the neck) are preserved. - The transected surface at the neck is anastomosed to the jejunum to maintain pancreatic drainage. *Duodenum* - The **entire duodenum** is resected during a Whipple operation. - This is necessary because the **head of the pancreas** is intimately involved with the duodenum, sharing blood supply and lymphatic drainage. *Head of pancreas* - The **head of the pancreas** is the primary target for resection in a Whipple procedure. - This is typically performed for **malignancies** (pancreatic or periampullary tumors) or severe inflammatory conditions affecting this region. *Common bile duct* - The **distal common bile duct** is resected as part of the specimen to ensure complete tumor excision with adequate margins. - The remaining **proximal common bile duct** is then anastomosed to the jejunum (hepaticojejunostomy).
Question 1272: CA Breast may locally spread to all of the following muscles except
- A. Latissimus Dorsi (Correct Answer)
- B. Pectoralis Minor
- C. Serratus Anterior
- D. Pectoralis Major
Explanation: ***Latissimus Dorsi*** - The **latissimus dorsi** muscle is located on the posterior aspect of the trunk and arm, significantly deeper and further away from the breast tissue compared to other surrounding muscles. - Direct local invasion of breast cancer to the latissimus dorsi is rare and typically requires extensive tumor growth or metastasis to more distant sites before affecting this muscle. *Pectoralis Minor* - The **pectoralis minor** muscle lies directly beneath the pectoralis major and is in close proximity to the deeper aspects of the breast tissue. - Tumors that invade the **deep fascia** of the breast can directly extend into this muscle. *Serratus Anterior* - The **serratus anterior** muscle is located on the lateral wall of the thorax, forming part of the chest wall beneath the breast. - **Aggressive breast cancers**, particularly those in the outer quadrants, can invade the fascial planes covering this muscle. *Pectoralis Major* - The **pectoralis major** forms the anterior wall of the axilla and lies directly beneath the majority of the breast tissue. - It is one of the most common muscles to be affected by **direct local invasion** from breast cancer due to its anatomical proximity.
Question 1273: A 45-year-old female underwent a modified radical mastectomy with axillary clearance for breast cancer. Post-surgery, she is unable to lift her arm above her head. Which nerve is most likely to be injured?
- A. Intercostobrachial nerve
- B. Nerve to latissimus Dorsi
- C. Lateral Pectoral nerve
- D. Long thoracic nerve of Bell (Correct Answer)
Explanation: ***Long thoracic nerve of Bell*** - Injury to the **long thoracic nerve** (nerve to the serratus anterior) leads to **paralysis of the serratus anterior muscle**. - This muscle is crucial for **upward rotation and protraction of the scapula**, which is essential for arm elevation above the head and preventing **'winging' of the scapula**. *Intercostobrachial nerve* - Injury to the **intercostobrachial nerve** typically causes **sensory loss** or numbness in the medial upper arm. - It does not primarily affect motor function or the ability to lift the arm. *Nerve to latissimus Dorsi* - The **thoracodorsal nerve** innervates the **latissimus dorsi muscle**, which is involved in adduction, extension, and internal rotation of the arm. - Injury to this nerve would impair these movements but not directly prevent arm elevation above the head. *Lateral Pectoral nerve* - The **lateral pectoral nerve** supplies the **pectoralis major muscle**, primarily its clavicular head. - Injury would weaken adduction and flexion of the arm, but the inability to lift the arm above the head strongly points to serratus anterior dysfunction.
Question 1274: A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is
- A. Fibroadenoma (Correct Answer)
- B. Cystasarcoma Phylloides
- C. Scirrhous Carcinoma
- D. Fibroadenosis
Explanation: ***Fibroadenoma*** - This is the most common benign breast tumor in young women, typically presenting as a **mobile, non-tender, firm mass** with no attachment to surrounding tissues. - The history of a **non-progressive mass** over six months in a 22-year-old woman is highly characteristic of a fibroadenoma. *Cystasarcoma Phylloides* - While it can present as a mobile mass, phyllodes tumors tend to grow **rapidly** and can reach a large size, which contradicts the "non-progressive" nature of the mass described. - Phyllodes tumors often have a **leaf-like architectural pattern** histologically and can be benign, borderline, or malignant. *Scirrhous Carcinoma* - This is a type of invasive ductal carcinoma that typically presents as a **hard, irregular, fixed mass** that is often attached to the skin or underlying tissue, unlike the mobile mass described here. - It is common in older women and often associated with **skin dimpling** or nipple retraction. *Fibroadenosis* - This refers to a group of benign breast changes, often presenting with generalized **lumpiness, pain, or tenderness** that fluctuates with the menstrual cycle, rather than a discrete, solitary mass. - It usually presents as **multiple, diffuse nodules** rather than a single, well-defined mass.