NEET-PG 2018 Practice Questions

Q: A 15-year-old boy presents with abdominal cramps and diarrhea for 8 weeks along with delayed puberty. Perianal examination reveals the following. What is the diagnosis? (NEET Pattern 2018)

Crohn's disease. ***Crohn's disease*** - The combination of **chronic abdominal cramps and diarrhea**, **delayed puberty**, and the presence of **perianal lesions** (like skin tags, fissures, or abscesses, as depicted) is highly indicative of Crohn's disease. - Delayed puberty suggests **malabsorption** and chronic inflammation, which are characteristic systemic effects of Crohn's disease, particularly when it affects the small bowel. *Celiac disease* - While celiac disease can cause **abdominal cramps**, **diarrhea**, and **growth delays** (potentially leading to delayed puberty due to malabsorption), it typically does **not present with perianal lesions**. - It is an **autoimmune response to gluten**, not an inflammatory bowel disease presenting with perianal manifestations. *Ulcerative colitis* - This condition is characterized by **colonic inflammation**, causing symptoms like **bloody diarrhea** and abdominal pain. - While it can manifest with some **extraintestinal symptoms**, **perianal disease** is rare and less severe compared to Crohn's disease, and delayed puberty is less commonly associated. *Irritable bowel syndrome* - IBS is a **functional gastrointestinal disorder** without underlying structural or biochemical abnormalities, presenting with abdominal pain and altered bowel habits. - It does **not cause perianal lesions**, malabsorption, or systemic complications like delayed puberty.

Q: The given endoscopy of the patient shows? (NEET Pattern 2018)

Eosinophilic esophagitis. **Eosinophilic esophagitis** - The endoscopic image displays prominent **concentric rings** (trachealization) and **linear furrows**, which are classic findings in eosinophilic esophagitis. - These features result from chronic inflammation and fibrosis caused by an allergic reaction leading to significant eosinophil infiltration in the esophageal wall. *Radiation esophagitis* - Endoscopic findings in radiation esophagitis typically include **erythema**, **edema**, **ulcerations**, or **strictures** in the irradiated field. - The characteristic ringed appearance seen in the image is not typical for radiation-induced injury. *GERD* - Endoscopic signs of GERD often include **erosions**, **ulcerations**, **strictures**, or **Barrett's esophagus**, usually in the distal esophagus. - While chronic GERD can cause inflammation, it typically does not produce the pronounced concentric rings and linear furrows characteristic of eosinophilic esophagitis. *Carcinoma esophagus* - Esophageal carcinoma typically presents with a **mass**, **ulceration**, **stricture**, or an **irregular, friable lesion**. - The image does not show any focal mass or destructive lesion suggestive of malignancy.

Q: Which is not a true statement about this anomaly of kidney?

No risk of Wilms tumor. ***No risk of Wilms tumor*** - Horseshoe kidney, the anomaly described, actually has an **increased risk of Wilms tumor**, not no risk. - The risk is about 2-8 times higher than in the general population. *Fusion of lower poles of the kidneys* - This is the **classic anatomical description** of a horseshoe kidney, where the lower poles are fused across the midline [1]. - The fusion typically occurs at the **isthmus**, which can be fibrous or parenchymatous. *Association with Turner syndrome* - Horseshoe kidney is indeed **commonly associated with Turner syndrome** (XO karyotype). - Approximately 15-20% of individuals with Turner syndrome have a horseshoe kidney. *Renal function usually is normal* - In most cases, the **renal function of a horseshoe kidney is normal** [1], provided there are no other associated anomalies or complications. - However, they are more prone to complications like **hydronephrosis**, **calculi**, and infections due to altered anatomy. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 545-546.

Q: In a neonate with the following findings, what is the likely etiology of hypothyroidism? (NEET Pattern 2018)

Thyroid dysgenesis. ***Thyroid dysgenesis*** - The image shows a neonate with **cretinism features** (e.g., puffy face, large tongue, umbilical hernia) and a **newborn screening card** being collected (heel prick blood spots). - **Thyroid dysgenesis** (aplasia, hypoplasia, or ectopic thyroid) is the most common cause of **congenital hypothyroidism**, accounting for about 85% of cases. *Chronic lymphocytic thyroiditis* - Also known as **Hashimoto's thyroiditis**, this is an **autoimmune condition** that primarily affects adults and older children, not typically neonates. - While it can lead to hypothyroidism, it is an **acquired** rather than a congenital cause. *Thyroid dyshormonogenesis* - This refers to genetic defects in the **synthesis of thyroid hormones** due to enzymatic deficiencies within a structurally normal thyroid gland. - While it is a **congenital cause** of hypothyroidism, it is less common than thyroid dysgenesis (accounting for about 10-15% of cases). *None of above* - This option is incorrect because **thyroid dysgenesis** is a highly likely etiology given the clinical presentation and context of newborn screening.

Q: The ultrasound finding of a 7 -month-old child with abdominal pain and mass in the upper abdomen is shown below. What is the diagnosis? (NEET Pattern 2018)

Intussusception. ***Intussusception*** - The ultrasound image clearly shows a "target sign" or "doughnut sign," which is pathognomonic for **intussusception**, where one segment of the intestine telescopes into another. - This condition commonly presents in infants (around 6-36 months) with **abdominal pain**, an abdominal mass, and sometimes **currant jelly stools**. *Intestinal volvulus* - **Intestinal volvulus** involves the twisting of the intestine around its mesentery, which would typically show a "whirlpool sign" on ultrasound due to twisted mesenteric vessels, not the "target sign." - It usually presents with sudden onset of severe abdominal pain, bilious vomiting, and signs of intestinal obstruction and ischemia. *Pyloric stenosis* - **Pyloric stenosis** is characterized by hypertrophy of the pyloric muscle, which would appear as an elongated, thickened pyloric canal on ultrasound with increased pyloric muscle thickness (>3mm) and length (>15mm). - Clinical presentation involves non-bilious projectile vomiting in infants, typically between 2 and 8 weeks of age, not at 7 months with an abdominal mass and the bowel-within-bowel appearance shown. *None of above* - The classic ultrasound findings and clinical presentation strongly point to intussusception, making this option incorrect.

Q: A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - The image shows a **braided absorbable suture**, which undergoes absorption through **tissue reaction** involving enzymatic breakdown and phagocytosis - This is the characteristic mechanism of absorption for most **absorbable sutures** (both natural like catgut and synthetic like Vicryl, Monocryl, PDS) - The body's macrophages phagocytose suture particles while proteolytic enzymes break down the material components, allowing complete removal from tissues *Derived from catgut* - While **catgut sutures** (derived from sheep/bovine intestinal submucosa) are absorbable, modern synthetic absorbable sutures like **polyglactin (Vicryl)** or **polyglycolic acid (Dexon)** are more commonly used - The image appearance and braided structure suggest a synthetic absorbable suture rather than catgut - Catgut is less commonly used today due to higher tissue reactivity and unpredictable absorption *Non-absorbable* - **Non-absorbable sutures** (silk, nylon, polypropylene) remain permanently in tissues or require removal - The mechanism of absorption by phagocytosis and enzymatic degradation specifically defines **absorbable sutures**, making this option incorrect - Non-absorbable sutures maintain tensile strength indefinitely *Absorbed over 3 months* - Absorption time varies significantly by suture type: **rapidly absorbing gut (5-7 days)**, **Vicryl (56-70 days)**, **PDS (180-210 days)** - While some sutures absorb around 90 days, this is not a universal characteristic - The statement is too specific and not applicable to all absorbable sutures shown

Q: The radiographic image shows a stent in the urinary tract. This type of stenting is most commonly performed following which procedure?

Pyeloplasty. ***Pyeloplasty*** - **Double J stents** are routinely placed in virtually all pyeloplasties (Anderson-Hynes dismembered pyeloplasty for **UPJO - Ureteropelvic Junction Obstruction**) to stent the anastomosis and ensure proper **urine drainage**. - The stent prevents **PUJ stricture** formation and supports healing of the surgical anastomosis, making it a standard postoperative measure. *ESWL* - **Extracorporeal Shock Wave Lithotripsy (ESWL)** rarely requires routine stenting unless there is **large stone burden** or risk of steinstrasse (stone fragment obstruction). - Stenting after ESWL is **selective**, not universally performed, unlike the routine nature implied by the question. *PCNL* - **Percutaneous Nephrolithotomy (PCNL)** primarily uses **nephrostomy tube** for drainage rather than double J stents as the first-line drainage method. - DJ stent placement after PCNL is **optional/selective**, not the most common stenting indication compared to pyeloplasty. *Ureteroscopy (URS)* - **Ureteroscopy** may require stenting in cases of **ureteral injury**, significant edema, or large stone burden, but it's placed **selectively**. - Unlike pyeloplasty, stenting after URS is **not universal** and depends on specific procedural factors and complications.

Q: During evaluation of a child with recurrent UTI, VCUG is performed and the following finding is observed. What is the diagnosis?

Posterior urethral valves. ***Posterior urethral valves*** - The image shows a **dilated and elongated posterior urethra** which is characteristic of posterior urethral valves (PUV). Also evident is **trabeculation of the bladder wall** and significant **bilateral vesicoureteral reflux (VUR)**, with a dilated and tortuous left ureter. - PUV frequently cause **recurrent UTIs** in male infants and children due to urinary obstruction and stasis, leading to bladder and upper tract damage. *Ureterocele* - A ureterocele would appear as a **cystic dilation of the distal ureter** into the bladder, typically visualized as a lucent defect within the opaque bladder on VCUG. The image does not show this specific finding. - While it can cause obstruction and VUR, the obstruction pattern observed in the image (especially the posterior urethra) is not consistent with a ureterocele. *Ectopic ureter* - An ectopic ureter involves the ureter inserting into an abnormal location, such as the vagina, urethra, or seminal vesicle, often bypassing the bladder. This would lead to a more direct drainage outside the bladder or into another structure without the gross changes seen in the posterior urethra. - While an ectopic ureter can lead to reflux or obstruction affecting the kidney, the primary obstruction in the **posterior urethra** with characteristic valve morphology is absent with an ectopic ureter. *Hydronephrosis* - **Hydronephrosis** refers to the swelling of a kidney due to a backup of urine, often caused by an obstruction or VUR. While hydronephrosis is a *consequence* of conditions like PUV, it is not the *diagnosis* explaining the direct VCUG findings in the bladder and urethra. - The VCUG directly visualizes the obstruction in the posterior urethra and associated reflux/bladder changes, which are the primary diagnostic features, rather than just the renal swelling.

Q: What does the following image show?

Stenting for pyeloplasty. ***Stenting for pyeloplasty*** - The image shows a **double J stent** placed in the ureter, which is commonly used to ensure **urine drainage** and **prevent stricture** after reconstructive surgeries like pyeloplasty. - The stent extends from the renal pelvis (upper coiled end) down into the bladder (lower coiled end), typical positioning for urinary tract procedures. *Stenting for bile duct obstruction* - Stents for **bile duct obstruction** are placed within the biliary system, which is anatomically distinct from the urinary tract shown. - These stents would be visible in the upper abdomen, associated with the liver and pancreas, not spanning the kidney and bladder as seen here. *Stenting for ESWL* - **Extracorporeal Shock Wave Lithotripsy (ESWL)** is a procedure to break up kidney stones; stents may be placed before or after to facilitate stone fragment passage or relieve obstruction. - While a stent might be placed after ESWL, the image itself shows the placement and course of the stent, which is a common intervention following reconstructive procedures such as pyeloplasty. *Stenting for PCNL* - **Percutaneous Nephrolithotomy (PCNL)** is a surgical procedure to remove large kidney stones directly from the kidney. - After PCNL, a **nephrostomy tube** or a **ureteral stent** may be placed, but the primary indication shown in the image (a long-term indwelling stent from kidney to bladder) is most consistent with facilitating healing and drainage after reconstruction such as pyeloplasty.

Question 1

A 15-year-old boy presents with abdominal cramps and diarrhea for 8 weeks along with delayed puberty. Perianal examination reveals the following. What is the diagnosis? (NEET Pattern 2018)

Accepted Answer

Crohn's disease

Answer

Celiac disease

Answer

Ulcerative colitis

Answer

Irritable bowel syndrome

Question 2

The given endoscopy of the patient shows? (NEET Pattern 2018)

Accepted Answer

Eosinophilic esophagitis

Answer

Radiation esophagitis

Answer

GERD

Answer

Carcinoma esophagus

Question 3

Which is not a true statement about this anomaly of kidney?

Accepted Answer

No risk of Wilms tumor

Answer

Fusion of lower poles of the kidneys

Answer

Association with Turner syndrome

Answer

Renal function usually is normal

Answer

Associated with increased risk of renal calculi

Question 4

In a neonate with the following findings, what is the likely etiology of hypothyroidism? (NEET Pattern 2018)

Accepted Answer

Thyroid dysgenesis

Answer

Chronic lymphocytic thyroiditis

Answer

Thyroid dyshormonogenesis

Answer

None of above

Question 5

The ultrasound finding of a 7 -month-old child with abdominal pain and mass in the upper abdomen is shown below. What is the diagnosis? (NEET Pattern 2018)

Accepted Answer

Intussusception

Answer

Intestinal volvulus

Answer

Pyloric stenosis

Answer

None of above

Question 6

A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

Derived from catgut

Answer

Non-absorbable

Answer

Absorbed over 3 months

Question 7

The radiographic image shows a stent in the urinary tract. This type of stenting is most commonly performed following which procedure?

Accepted Answer

Pyeloplasty

Answer

ESWL

Answer

PCNL

Answer

Ureteroscopy (URS)

Question 8

This 1-day-old neonate presents with bilious vomiting and progressive abdominal distension. Antenatal ultrasound reveals echogenic bowel in fetus. Barium enema findings are shown. What is likely diagnosis?

Accepted Answer

Cystic fibrosis

Answer

Duodenal atresia

Answer

Hirschsprung disease

Answer

Gastroenteritis

Answer

Meconium plug syndrome

Question 9

During evaluation of a child with recurrent UTI, VCUG is performed and the following finding is observed. What is the diagnosis?

Accepted Answer

Posterior urethral valves

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Hydronephrosis

Question 10

What does the following image show?

Accepted Answer

Stenting for pyeloplasty

Answer

Stenting for bile duct obstruction

Answer

Stenting for ESWL

Answer

Stenting for PCNL

NEET-PG 2018

Internal Medicine

Pathology

Pediatrics

Radiology

Surgery