NEET-PG 2018 Practice Questions

Q: What is the most common indication for performing a tracheostomy?

Prolonged mechanical ventilation. ***Prolonged mechanical ventilation*** - Maintaining an **endotracheal tube** for an extended period carries risks like **tracheal injury**, **vocal cord damage**, and difficulty with oral intake. - A tracheostomy provides a more comfortable and stable airway for **long-term respiratory support**, facilitates weaning from the ventilator, and reduces the risk of **ventilator-associated pneumonia**. *Severe obstructive sleep apnea* - While tracheostomy can effectively treat severe OSA by bypassing the upper airway obstruction, it is generally considered a **last resort** after less invasive treatments have failed. - The most common initial treatments for OSA include **CPAP**, weight loss, and oral appliances. *Tracheal stenosis* - Tracheal stenosis itself is a **structural narrowing** of the trachea that may or may not require tracheostomy, depending on its severity and location. - While a tracheostomy can bypass a severe stenosis, surgical repair of the trachea is often the definitive treatment for **severe tracheal stenosis**. *Vocal cord paralysis* - Unilateral vocal cord paralysis typically causes **hoarseness** and may not always necessitate a tracheostomy. - Bilateral vocal cord paralysis can lead to **airway obstruction**, but intervention usually involves vocal cord lateralization procedures or, in severe cases, a tracheostomy for airway patency.

Q: Choose the best method of diagnosis for the clinical sign represented in the image.

Serum ceruloplasmin. ***Serum ceruloplasmin*** - The image shows a **Kayser-Fleischer ring**, a greenish-brown discoloration in the periphery of the cornea, which is pathognomonic for **Wilson's disease**. - **Wilson's disease** is a genetic disorder of copper metabolism characterized by **low serum ceruloplasmin** levels (the primary copper-carrying protein in the blood) and increased copper deposition in various tissues. *Serum copper* - While Wilson's disease involves copper accumulation, **total serum copper** can be normal or even elevated due to widespread tissue damage releasing copper into the circulation, making it an unreliable diagnostic marker on its own. - A low serum copper level can be seen, but it is not as specific as low ceruloplasmin, as much of the copper in serum is bound to ceruloplasmin. *Karyotyping* - **Karyotyping** is used to analyze the number and structure of chromosomes and is primarily indicated for diagnosing chromosomal abnormalities, such as Down syndrome or Turner syndrome. - It is not relevant for diagnosing metabolic disorders like Wilson's disease, which is caused by a mutation in a single gene (ATP7B), not a chromosomal aberration. *PCR* - **PCR (Polymerase Chain Reaction)** is a technique used to amplify DNA sequences and can be used for genetic testing to identify specific mutations. - While genetic testing for the **ATP7B gene** mutation is a confirmatory test for Wilson's disease, it is not the primary or best method for initial diagnosis, especially when classic clinical signs and biochemical markers (like low ceruloplasmin) are present.

Q: Which condition is associated with the ECG pattern known as pseudo P pulmonale?

Hypercalcemia. ***Hypercalcemia*** - **Hypercalcemia** can cause a characteristic ECG pattern known as pseudo P pulmonale due to its effects on **myocardial repolarization**. - This condition leads to a **shortened QT interval** which causes the T wave to merge with the P wave, giving the appearance of a tall, peaked P wave. *Hypokalemia* - **Hypokalemia** typically presents with **flattened T waves**, prominent U waves, and ST-segment depression on an ECG [1]. - It can prolong repolarization, which is the opposite effect observed with pseudo P pulmonale [1]. *Hyponatremia* - **Hyponatremia** has a less defined direct effect on ECG patterns compared to other electrolyte imbalances. - Severe hyponatremia may lead to **QRS widening** or **bradycardia**, but not pseudo P pulmonale [1]. *Hypocalcemia* - **Hypocalcemia** characteristically causes **prolongation of the QT interval** on an ECG due to delayed ventricular repolarization [2]. - This is distinct from the shortened QT seen in hypercalcemia that contributes to pseudo P pulmonale.

Q: Identify the X-ray HSG image shown below:

Unicornuate uterus. ***Unicornuate uterus*** - The image distinctly shows a **single, banana-shaped uterine horn** with only one fallopian tube visible, characteristic of a unicornuate uterus resulting from the unilateral arrest of Mullerian duct development. - The contrast material preferentially fills this single cavity, and there is no evidence of a second, rudimentary horn or a bilobed appearance. *Septate uterus* - A septate uterus would show a **normal uterine contour externally** but an **internal septum** dividing the uterine cavity into two cornua. - The image does not show a bilobed uterine cavity with a dividing septum; instead, it demonstrates a single, elongated horn. *Uterus didelphys* - Uterus didelphys involves **two completely separate uteri**, each with its own cervix and vagina, resulting from a complete failure of Mullerian duct fusion. - The image displays a single uterine cavity, not two distinct uterine bodies. *Bicornuate uterus* - A bicornuate uterus is characterized by a **heart-shaped external contour** with a deep fundal indentation and two divergent uterine horns, though often sharing a single cervix and vagina. - The image does not present a prominent fundal indentation or two distinct uterine horns, but rather a single, slender horn.

Q: A patient has a history of RTA 2 years ago. He developed pain and swelling at the same site. What will be the diagnosis based on the provided X-ray features?

Chronic osteomyelitis. ***Chronic osteomyelitis*** - The history of an **RTA 2 years ago** suggests a prior injury or open fracture, which is a common predisposing factor for chronic osteomyelitis. - The X-ray shows changes consistent with chronic infection, such as **bony sclerosis**, **lytic areas** (abscesses/sequestration), and possibly **periosteal reaction**, indicating persistent inflammation and bone destruction. *Osteogenic sarcoma* - This is a **primary malignant bone tumor** typically presenting with aggressive periosteal reaction (**sunburst** or **Codman's triangle**) and rapid bone destruction, which are not the predominant features here. - While it can cause pain and swelling, the history of a remote RTA followed by a chronic course makes osteogenic sarcoma less likely than infection. *Ewing's sarcoma* - This is another **highly malignant bone tumor** known for its characteristic **onion-skin periosteal reaction** and lytic lesions, often presenting in younger individuals. - The X-ray features do not clearly depict the characteristic onion-skin appearance, and the temporal history suggests a chronic inflammatory process rather than an aggressive de novo tumor. *Multiple myeloma* - This is a **plasma cell malignancy** characterized by multiple punched-out lytic lesions in the bone, often affecting the axial skeleton. - The X-ray image shows a more localized and heterogeneous pattern of bone changes, including sclerosis and reactive bone formation, which are not typical for multiple myeloma.

Q: Identify the condition shown in the image of the lung.

Lobar pneumonia. ***Lobar Pneumonia*** - Characterized by **consolidation of lung lobes** due to infection, commonly seen in cases of **Streptococcus pneumoniae** [1]. - Classic clinical features include **fever, cough, and difficulty breathing**, often with rust-colored sputum. *Congested kidney* - Indicates **kidney enlargement and edema** due to vascular congestion, often associated with heart failure. - Symptoms primarily relate to **renal function decline**, not pulmonary involvement. *Bronchopneumonia* - Typically shows **patchy consolidations** throughout different lung regions [2] [3], rather than a single lobe. - More common in **post-viral infections** and associated with a **sicker patient overall** [3], presenting diffuse symptoms. *Acute glomerulonephritis* - Primarily a **renal condition** resulting in hematuria and proteinuria, with **no respiratory involvement**. - Often follows infections, such as from **streptococci**, manifesting as nephritic syndrome rather than pneumonia symptoms. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 709-712. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 317-318. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 316-317.

Q: Positive periodic acid-Schiff (PAS) macrophages are seen in which of the following conditions?

Whipple's disease. ***Whipple's disease*** - **Whipple's disease** is caused by the bacterium *Tropheryma whipplei*, which is ingested by macrophages and accumulates in their lysosomes [1]. - The bacterial cell wall contains **glycoproteins** and **proteoglycans** that stain magenta (red-purple) with the **periodic acid-Schiff (PAS)** stain. - PAS-positive, diastase-resistant macrophages in the lamina propria of the small intestine are **pathognomonic** for Whipple's disease [1]. *Crohn's disease* - Crohn's disease is an **inflammatory bowel disease** characterized by transmural inflammation and non-caseating granulomas. - While it involves macrophages in the inflammatory process, they do not typically show **PAS-positive inclusions**. *HIV/AIDS* - HIV/AIDS is a **viral infection** that primarily targets CD4+ T lymphocytes and macrophages. - Although macrophages are involved in HIV infection and can be found in intestinal tissue, they do not exhibit **PAS-positive inclusions** characteristic of Whipple's disease. *Celiac disease* - Celiac disease is an **autoimmune enteropathy** triggered by gluten, causing villous atrophy and malabsorption. - The histology shows increased intraepithelial lymphocytes and crypt hyperplasia, but **macrophages are not PAS-positive**. - Both Whipple's and celiac disease can present with malabsorption, making clinical differentiation important [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 798-799.

Q: Identify the condition represented in the image of a testicular tumor.

Seminoma. ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.

Q: Identify the condition represented in the chest radiograph.

Miliary tuberculosis. ***Miliary tuberculosis*** - The chest radiograph displays numerous small, well-demarcated **nodules (1-3 mm)** scattered diffusely and uniformly throughout both lung fields. - This widespread, uniform distribution of **miliary nodules** resembling millet seeds is pathognomonic for **miliary tuberculosis**, indicating hematogenous dissemination of *Mycobacterium tuberculosis*. - The **bilateral, symmetrical involvement** with countless tiny nodules of uniform size is characteristic. *Bronchiectasis* - Bronchiectasis on chest radiograph shows **dilated, thickened bronchi** appearing as parallel linear opacities ("tram-track sign") or ring-like structures. - **Increased bronchovascular markings** and areas of cystic lucencies may be visible, not the diffuse miliary nodular pattern seen here. *COPD* - COPD shows **hyperinflation** with flattened diaphragms, increased retrosternal airspace, and bullae. - **Emphysema** produces areas of hyperlucency and vascular attenuation, while **chronic bronchitis** shows increased bronchovascular markings and peribronchial thickening. - Neither produces the uniform miliary nodular pattern characteristic of this image. *Lung cancer* - Primary lung cancer typically presents as a **solitary pulmonary nodule or mass**, often with irregular margins and associated findings like lymphadenopathy or pleural effusion. - While **pulmonary metastases** can present as multiple nodules, they are typically **larger (>5 mm), variable in size**, and less uniformly distributed than the miliary pattern seen here.

Q: Which type of retractor is shown in the image?

Morris retractor. ***Morris retractor (Correct Answer)*** - The image displays a **Morris retractor**, characterized by its slightly curved blade and often a single, broad blade or sometimes two blades for wider retraction. - It is a type of **hand-held retractor**, commonly used in general surgery, orthopedic surgery, and some deep abdominal procedures to retract skin, subcutaneous tissue, and muscle. *Czerny retractor (Incorrect)* - A Czerny retractor typically has **two L-shaped blades** that can be of different lengths, allowing fine adjustment for delicate tissue retraction. - It is often seen in **more superficial surgeries** and less for deep muscle retraction. *Richardson retractor (Incorrect)* - A Richardson retractor usually has a **single, right-angled blade** that is L-shaped, and the handle is often wider for a better grip. - It is also a **hand-held retractor** frequently used for medium depth retraction in various surgical fields. *Lower lid retractor (Incorrect)* - A lower lid retractor is specifically designed for **ophthalmic surgery**, used to gently hold down the lower eyelid. - It has a very **small, delicate, and often curved or spoon-shaped blade** suitable for the delicate tissues around the eye, which is clearly not what is depicted in the image.

Question 1

What is the most common indication for performing a tracheostomy?

Accepted Answer

Prolonged mechanical ventilation

Answer

Severe obstructive sleep apnea

Answer

Tracheal stenosis

Answer

Vocal cord paralysis

Question 2

Choose the best method of diagnosis for the clinical sign represented in the image.

Accepted Answer

Serum ceruloplasmin

Answer

Serum copper

Answer

Karyotyping

Answer

PCR

Question 3

Which condition is associated with the ECG pattern known as pseudo P pulmonale?

Accepted Answer

Hypercalcemia

Answer

Hyponatremia

Answer

Hypocalcemia

Answer

Hypokalemia

Question 4

Identify the X-ray HSG image shown below:

Accepted Answer

Unicornuate uterus

Answer

Septate uterus

Answer

Uterus didelphys

Answer

Bicornuate uterus

Question 5

A patient has a history of RTA 2 years ago. He developed pain and swelling at the same site. What will be the diagnosis based on the provided X-ray features?

Accepted Answer

Chronic osteomyelitis

Answer

Osteogenic sarcoma

Answer

Ewing's sarcoma

Answer

Multiple myeloma

Question 6

Identify the condition shown in the image of the lung.

Accepted Answer

Lobar pneumonia

Answer

Bronchopneumonia

Answer

Pulmonary infarction

Answer

Lung abscess

Question 7

Positive periodic acid-Schiff (PAS) macrophages are seen in which of the following conditions?

Accepted Answer

Whipple's disease

Answer

Crohn's disease

Answer

HIV/AIDS

Answer

Celiac disease

Question 8

Identify the condition represented in the image of a testicular tumor.

Accepted Answer

Seminoma

Answer

Non-seminomatous germ cell tumor

Answer

Teratoma (testicular tumor)

Answer

Leydig cell tumor

Question 9

Identify the condition represented in the chest radiograph.

Accepted Answer

Miliary tuberculosis

Answer

Bronchiectasis

Answer

COPD

Answer

Lung cancer

Question 10

Which type of retractor is shown in the image?

Accepted Answer

Morris retractor

Answer

Czerny retractor

Answer

Richardson retractor

Answer

Lower lid retractor

NEET-PG 2018

ENT

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology

Radiology

Surgery