NEET Pattern Questions

Lung cancer

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Q) A 73 year male,  old heavy smoker presents with haemoptysis. On examination he is cachectic and shows evidence of clubbing. Imaging shows a main bronchial tumour with massive mediastinal lymphadenopathy together with widespread visceral metastases. Which of the following variant is likely in him?

( Theme from mock test 12- 24) 

a)  Adenocarcinoma
B.  Small cell lung cancer
C. Large cell lung cancer
D. Squamous cell carcinoma

  • Patient: 73-year-old male, heavy smoker
  • Symptoms: Hemoptysis, cachexia, clubbing
  • Imaging: Main bronchial tumor with massive mediastinal lymphadenopathy and widespread visceral metastases

Likely Variant:

B. Small cell lung cancer (SCLC) is the most likely diagnosis.

Rationale:

  • Small Cell Lung Cancer: This type of cancer is strongly associated with heavy smoking and is characterized by aggressive behavior and early metastasis. Most patients present with disseminated disease, as seen in this case.
  • Clinical Features: The combination of hemoptysis, cachexia, and clubbing aligns well with SCLC, which can also lead to various paraneoplastic syndromes.
  • Other Tumors:
    • Adenocarcinoma: More common in never smokers and typically peripheral, not fitting the profile here.
    • Squamous Cell Carcinoma: Generally grows slower and is also typically centrally located, but not usually associated with such widespread metastasis at presentation.
    • Large Cell Lung Cancer: While it can be aggressive, it’s less commonly associated with extensive lymphadenopathy and visceral metastases compared to SCLC.

Thyroid storm

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Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks. She presented in emergency with high grade fever and hypotension. ( Thyroid Storm) .What is not a part of further management?

a) Oxygen

b) Beta blockers

c) Radio active Iodine

d) Lugol's idodine

Thyroid MCqs

Ans c

Explanation:
In the management of a thyroid storm, radioactive iodine (RAI) is not used. RAI is a predisposing factor for thyroid storm, not a treatment. The management includes beta blockers, oxygen and hemodynamic support, IV Lugol iodine, PTU (propylthiouracil), and corticosteroids.

Empyema chest

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Q) Empyema stage II management is ? Theme  from upcoming mock test 25 on 29.9.24

 

a) VATs

b) Decortication Open

c) IV antibiotics

d) Antibiotics and drainage

Ans d

Antibiotics and drainage

60 years ago, The American Thoracic Society first described the evolution of empyema as a continuous process that subdivides into three stages.

Exudative stage -

initial bacterial infection causes an acute inflammatory response between the pulmonary parenchyma and visceral pleural.

This exudative fluid is usually free-flowing, resolves with appropriate antibiotic treatment, and does not warrant any invasive drainage.

Fibrinopurulent and Loculated stage II)  In the absence of appropriate treatment, the effusion can become complicated via deposition of fibrin clots and membranes resulting in isolated collections of fluid in the pleural space

.At this stage, bacteriology usually becomes positive, and the effusion warrants antimicrobials and drainage.

Chronic Organizational stage - if not drained, fibroblasts coalesce to form a thick pleural peel between the visceral and parietal pleura. This peel can ultimately encase the underlying lung parenchyma and can complicate the clinical course via inhibition of adequate gas exchange, trapped lung or chronic forms of empyema.

Amylase and Lipase in Acute pancreatitis

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Q) Which of the following is false regarding amylase and lipase in acute pancreatitis?
a) Amylase more than 3 times above normal indicates acute pancreatitis
b) Normal serum amylase does not rule out acute pancreatitis
c) Serum lipase is more specific than serum amylase
d) Serum amylase is more sensitive than serum lipase

MCQs on Pancreatitis 

Q) Why does amylase and lipase increase in pancreatitis?

A) They are released from the acinar cells of pancreas during injury

Q) When does serum amylase rise in acute pancreatitis?

A) Within the first 12 hours

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