NEET-PG 2017 Practice Questions

Q: A 30-year-old AIDS patient presents with complaints as shown below. All are true about the condition except?

Benign tumor. ***Benign tumor*** - **Kaposi's sarcoma** is a **malignant vascular tumor** characterized by abnormal proliferation of endothelial cells, making the statement that it's a benign tumor incorrect. - The lesions shown in the image (purplish-red to brownish plaques and nodules on the lower leg, typical in an AIDS patient) are highly suggestive of Kaposi's sarcoma, which is definitively not benign. *Vascular tumor* - **Kaposi's sarcoma** is indeed a **vascular tumor** that arises from endothelial cells and is characterized by the formation of new blood vessels. - The appearance of the lesions in the image, with their characteristic color and nodular/plaque-like morphology, is consistent with their vascular origin. *Not seen in transfusion related AIDS* - **Kaposi's sarcoma** can occur in individuals with **AIDS resulting from any mode of transmission**, including transfusion-related AIDS, as it is linked to the immunosuppression caused by HIV, not the specific mode of acquisition. - While it's more commonly associated with certain risk groups (e.g., homosexual men), the underlying immunosuppression is the key factor, meaning it can manifest regardless of how HIV was acquired. *HHV 8* - **Kaposi's sarcoma** is strongly associated with and considered a B-cell lymphotropic infection caused by the **Human Herpesvirus 8 (HHV-8)**, also known as Kaposi's sarcoma-associated herpesvirus (KSHV). - HHV-8 infection is a prerequisite for the development of Kaposi's sarcoma, particularly in immunocompromised individuals like those with AIDS.

Q: A patient presents with abdominal pain, diarrhea and weight loss. He gives past history of pulmonary TB. Barium film of the patient indicates which of the following condition?

Pulled up cecum. ***Pulled up cecum*** - The barium study shows an **abnormally high position** of the cecum, often caused by **adhesions** or **inflammatory processes** from previous infections like TB. - The **String sign of Kantor** (narrowed bowel segments appearing as thin strings) indicates **inflammatory bowel involvement**, commonly seen in **TB enteritis** or **Crohn's disease**. *Intestinal obstruction* - Would show **dilated bowel loops** proximal to the obstruction with **air-fluid levels** and minimal contrast passage beyond the blockage. - The radiological findings described (pulled up cecum and string sign) do not indicate mechanical obstruction. *Intestinal perforation* - Would demonstrate **extraluminal contrast leak** into the peritoneal cavity on barium study, which is not present here. - Clinical presentation would be **acute peritonitis** with severe pain and signs of sepsis, not chronic symptoms. *Diverticulum formation* - Would show **sac-like outpouchings** (diverticula) from the bowel wall, which are **not visualized** on this barium study. - The described findings of **string sign** and **cecal displacement** are inconsistent with diverticular disease.

Q: A 22-year-old female patient complains of discharge from the neck along with a previous history of midline neck swelling. Image of the patient is given below. All the statements regarding this patient are true except:

It is a complication of nodular goiter. ***It is a complication of nodular goiter*** - A **thyroglossal duct cyst** is a congenital anomaly resulting from the incomplete obliteration of the thyroglossal duct, a remnant of thyroid gland development. - While it can become infected or form a fistula, it is not a complication of an acquired thyroid condition like **nodular goiter**, which is an enlargement of the thyroid gland. *This is thyroglossal fistula* - The patient's history of a **midline neck swelling** with **discharge from the neck** is highly suggestive of an infected thyroglossal duct cyst that has ruptured or been incised, forming a thyroglossal fistula. - A fistula is an **abnormal tract** connecting an internal cavity to the surface, in this case, the remnant of the thyroglossal duct to the skin. *Sistrunk's operation is the treatment of choice* - The **Sistrunk procedure** involves excising the thyroglossal duct cyst along with the central portion of the hyoid bone and the core of muscle extending to the foramen cecum at the base of the tongue. - This extensive removal is necessary due to the embryological origin and the high risk of recurrence if any part of the duct system, especially near the hyoid bone, is left behind. *This discharge site will move upwards on protrusion of tongue* - The **thyroglossal duct** travels through the hyoid bone and is embryologically connected to the tongue. - Therefore, structures within the persistent thyroglossal track, including a fistula, will move upwards with the **protrusion of the tongue**, which is a classic diagnostic sign.

Q: All of the following are true regarding this picture except: (Recent NEET Pattern 2016-17)

Usually bilateral. ***Usually bilateral*** - Paget's disease of the nipple, as depicted in the image (lesions on the nipple with surrounding dermatitis-like changes), is almost always an **unilateral condition**. - Its bilateral occurrence is exceedingly rare and would suggest a different or coincidental pathology. - **This is the FALSE statement** - Paget's disease is typically unilateral, not bilateral. *Associated with underlying invasive carcinoma of breast* - **Paget's disease of the nipple** is histologically characterized by the presence of **Paget cells** (adenocarcinoma cells) in the epidermis of the nipple and areola [2]. - In a vast majority of cases (90-95%), it is associated with an underlying **ductal carcinoma in situ (DCIS)** or an **invasive ductal carcinoma** originating from the lactiferous ducts [1], [2]. *Itching is a common symptom* - **Itching (pruritus)** is a **prominent and common symptom** of Paget's disease of the nipple, along with burning, pain, and crusting. - The eczematous changes often lead to significant discomfort and itching. *Treatment is simple mastectomy with axillary lymph node dissection* - The standard treatment for Paget's disease of the nipple, especially when associated with an underlying invasive carcinoma, is **surgical excision**. - A **simple mastectomy** removes the entire breast and is often combined with **axillary lymph node dissection** or sentinel lymph node biopsy to assess for nodal involvement [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062.

Q: A splenorenal shunt procedure may be required for treatment of:

Bleeding esophageal varices. ***Bleeding esophageal varices*** - A **splenorenal shunt** (Warren shunt) creates an anastomosis between the **splenic vein** and **left renal vein**, effectively decompressing the **portal venous system** and reducing pressure in esophageal varices. - This procedure is specifically indicated for **portal hypertension** with recurrent variceal bleeding that is refractory to medical management and endoscopic interventions. *Mesenteric ischemia* - Mesenteric ischemia results from **inadequate arterial blood supply** to the bowel, typically due to **atherosclerotic disease** or **embolic occlusion** of mesenteric arteries. - Treatment involves **arterial revascularization** procedures like bypass grafting or angioplasty, not portal venous shunting. *Injury to tail of pancreas* - Pancreatic tail injuries are managed with **distal pancreatectomy** with or without splenectomy, depending on the extent of ductal involvement and tissue viability. - This condition requires **direct surgical repair** of the injured pancreatic tissue, not modification of portal venous drainage. *Liver laceration* - Liver lacerations are treated based on hemodynamic stability with **conservative management**, **surgical repair**, or **angiographic embolization** for active bleeding. - Management focuses on **controlling hemorrhage** and preserving hepatic function, not altering portal venous flow patterns.

Q: A 12-year-old patient with esophageal varices is managed by the procedure shown in the image. All of the following statements regarding this condition are true except:

This is the definitive treatment. ***This is the definitive treatment*** - The image shows a **Sengstaken-Blakemore tube** being used, which is a temporary measure for controlling **bleeding esophageal varices**. - It is an emergency treatment used for stabilization and does not address the underlying cause of varices or prevent future bleeding. - **Definitive treatments** include endoscopic variceal ligation (EVL), sclerotherapy, or TIPS procedure. *Sengstaken-Blakemore tube* - The device shown in the image, with balloons and multiple lumens, is indeed a **Sengstaken-Blakemore tube**, used for **tamponade of actively bleeding esophageal varices**. - This tube features a gastric balloon and an esophageal balloon, along with lumens for suction, designed to exert pressure on the bleeding varices. *Gastric balloon is inflated with 400 mL of air* - The **gastric balloon** of a Sengstaken-Blakemore tube is typically inflated with **200-500 mL of air** (often around 250-300 ml in adults, 150 ml in children) to anchor the tube and compress gastric varices. - While 400 mL is within the general range, the exact volume can vary based on patient size and clinical protocol. *Esophageal balloon is inflated with 40 mm Hg pressure of air* - The **esophageal balloon** is indeed inflated to a pressure of **20-45 mmHg (typically 30-45 mmHg)** to compress esophageal varices. - This pressure application is critical for achieving local hemostasis in acute bleeding episodes. *Should be kept inflated for a maximum of 24-48 hours* - The balloons should be deflated after **24-48 hours maximum** to prevent complications such as **esophageal necrosis, ulceration, or perforation**. - Prolonged inflation can cause pressure necrosis of the esophageal or gastric mucosa.

Q: A 29-year-old male who is a doctor by profession, gives a history of prolonged sitting in his OPD hours and presents with discharge and pain. Clinical presentation of the patient is given in the image. What is the most likely diagnosis?

Pilonidal sinus. ***Pilonidal sinus*** - The image shows a **pit** or **opening** in the **natal cleft** with surrounding inflammation and discharge, which is characteristic of a pilonidal sinus. - The history of **prolonged sitting** (*a doctor by profession has prolonged sitting hours in OPD*) and the patient's age (29-year-old male) are common risk factors for pilonidal disease. *Anal fissure* - An anal fissure is a **tear** in the **lining of the anal canal**, typically causing severe pain during and after defecation, and often bright red rectal bleeding. - The lesion in the image is located in the **natal cleft**, not within the anal canal, and presents as a sinus with discharge rather than a linear tear. *Anal fistula* - An anal fistula is an abnormal tunnel connecting the **anal canal to the skin outside** the anus, usually presenting as a small opening with intermittent or persistent discharge of pus or blood. - While it involves discharge, an **anal fistula** typically has an external opening closer to the anus, and the image clearly shows the lesion in the **sacrococcygeal region**, consistent with a pilonidal sinus. *Sentinel pile* - A sentinel pile is a **skin tag** that often accompanies a **chronic anal fissure**, located at the external edge of the fissure. - It is essentially excess skin and usually does not present with **discharge** or the characteristic **sinus tract** seen in the image.

Q: What is the preferred treatment for the shown lesion?

5-FU + Mitomycin C + Radiotherapy. ***5-FU + Mitomycin C + Radiotherapy*** - The image shows an **exophytic lesion near the anus**, which is highly suggestive of **anal squamous cell carcinoma (SCC)**. The preferred treatment for anal SCC is **chemoradiation**. - The regimen of 5-fluorouracil (5-FU) and Mitomycin C, combined with **radiotherapy**, is the **Nigro protocol**, which is the current standard of care for anal cancer, aiming for organ preservation and cure. - This non-surgical approach has replaced radical surgery for most anal cancers, with excellent cure rates and quality of life preservation. *5-fluorouracil + Mitomycin C* - While these chemotherapy agents are part of the standard treatment for anal SCC, they are typically used in conjunction with **radiotherapy** to achieve optimal outcomes. - Chemotherapy alone without radiation is generally insufficient for curative intent in anal SCC. *Mitomycin C + Cisplatin* - This combination includes two potent chemotherapy drugs, but it is not the standard protocol for anal SCC. - While cisplatin can be used in some anal cancer regimens (particularly as salvage therapy), the combination with Mitomycin C in the absence of 5-FU and radiotherapy is not the primary choice. *Abdominoperineal resection (APR)* - APR was historically the standard treatment for anal cancer but has been largely replaced by chemoradiation (Nigro protocol). - Surgery is now reserved for salvage therapy in cases of persistent or recurrent disease after chemoradiation failure. - The shift to chemoradiation has significantly improved quality of life by preserving the anal sphincter and avoiding permanent colostomy.

Question 1

A 30-year-old AIDS patient presents with complaints as shown below. All are true about the condition except?

Accepted Answer

Benign tumor

Answer

Vascular tumor

Answer

Not seen in transfusion related AIDS

Answer

HHV 8

Question 2

A patient presents with abdominal pain, diarrhea and weight loss. He gives past history of pulmonary TB. Barium film of the patient indicates which of the following condition?

Accepted Answer

Pulled up cecum

Answer

Intestinal obstruction

Answer

Intestinal perforation

Answer

Diverticulum formation

Question 3

A 51-year-old woman presents with complaints of nervousness and weight loss. She reveals that she has been feeling her heart racing often. On examination, she has a fine tremor, and a large mass in the front of her neck that moves when she swallows. What is the definite treatment of choice for this condition?

Accepted Answer

Total thyroidectomy

Answer

Subtotal thyroidectomy

Answer

Propranolol

Answer

${ }^{131} \mathrm{I}$ radioablation

Answer

Antithyroid drugs (Methimazole)

Question 4

All are true about the condition shown in the image except:

Accepted Answer

Overexpression of HER 2/neu shows poor response to adriamycin

Answer

Occurs due to lymphatics destruction

Answer

Peau d'orange

Answer

Van Nuys prognostic index

Question 5

A 22-year-old female patient complains of discharge from the neck along with a previous history of midline neck swelling. Image of the patient is given below. All the statements regarding this patient are true except:

Accepted Answer

It is a complication of nodular goiter

Answer

This is thyroglossal fistula

Answer

Sistrunk's operation is the treatment of choice

Answer

This discharge site will move upwards on protrusion of tongue

Question 6

All of the following are true regarding this picture except: (Recent NEET Pattern 2016-17)

Accepted Answer

Usually bilateral

Answer

Associated with underlying invasive carcinoma of breast

Answer

Itching is a common symptom

Answer

Treatment is simple mastectomy with axillary lymph node dissection

Question 7

A splenorenal shunt procedure may be required for treatment of:

Accepted Answer

Bleeding esophageal varices

Answer

Mesenteric ischemia

Answer

Injury to tail of pancreas

Answer

Liver laceration

Question 8

A 12-year-old patient with esophageal varices is managed by the procedure shown in the image. All of the following statements regarding this condition are true except:

Accepted Answer

This is the definitive treatment

Answer

Sengstaken-Blakemore tube

Answer

Gastric balloon is inflated with 400 mL of air

Answer

Esophageal balloon is inflated with 40 mm Hg pressure of air

Answer

Should be kept inflated for a maximum of 24-48 hours

Question 9

A 29-year-old male who is a doctor by profession, gives a history of prolonged sitting in his OPD hours and presents with discharge and pain. Clinical presentation of the patient is given in the image. What is the most likely diagnosis?

Accepted Answer

Pilonidal sinus

Answer

Anal fissure

Answer

Anal fistula

Answer

Sentinel pile

Question 10

What is the preferred treatment for the shown lesion?

Accepted Answer

5-FU + Mitomycin C + Radiotherapy

Answer

5-fluorouracil + Mitomycin C

Answer

Mitomycin C + Cisplatin

Answer

Abdominoperineal resection (APR)

NEET-PG 2017

Pathology

Radiology

Surgery