NEET SS practise tests

Nutritional Screening

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NRS-2002 Nutritional Screening MCQ | mcqsurgery.com
Q) According to NRS-2002, which patient needs nutritional intervention?
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Debakey Classification

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Aortic Dissection – DeBakey Classification MCQ

Clinical Scenario: A 52-year-old hypertensive male presents with sudden retrosternal chest pain radiating to the back. CT angiography reveals dissection confined to the ascending aorta without involvement of the arch or descending thoracic aorta.

Which DeBakey classification does this correspond to?

A. Type I
B. Type II
C. Type IIIa
D. Type IIIb

AFP & Embryomal cell carcinoma of Testis

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AFP in Pure Embryonal Cell Carcinoma MCQ | mcqsurgery.com
Q) Which of the following statements about alpha-fetoprotein (AFP) in pure embryonal cell carcinoma is most accurate?
✅ Answer: c) AFP is elevated in 50-80% of cases of pure embryonal cell carcinoma.

🔍 Explanation:
Alpha-fetoprotein (AFP) is a **tumor marker** commonly elevated in **non-seminomatous germ cell tumors** (NSGCTs), which includes **embryonal cell carcinoma**. AFP levels are elevated in approximately **50-80%** of cases of **pure embryonal carcinoma**, and this elevation is associated with the **yolk sac tumor component** that is often seen within these tumors.
  • AFP is a **glycoprotein** produced by the fetal liver and yolk sac, and its levels are typically **low in adults**.
  • It is elevated in conditions like **liver cancer**, **germ cell tumors**, and **yolk sac tumors** (which may be seen with embryonal carcinoma).
  • In **seminomas**, AFP is **usually normal**, and they are typically not associated with AFP elevation.
  • Correct interpretation of AFP levels is important for **diagnosis**, **monitoring treatment response**, and **detecting recurrence** in **germ cell tumors**.
Misinterpreting AFP levels can lead to **incorrect staging** or **diagnosis** of testicular cancers.
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GCS Intubated patient

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Multiple MCQs Example | mcqsurgery.com
Q1) What is the maximum possible GCS score for an intubated patient?
Show Answer & Explanation
✅ Answer: c) 11T

🔍 Explanation: In intubated patients, verbal cannot be assessed (T). Max score = Eye 4 + Motor 6 = 10, written as 11T. Explanation and Teaching Points: Intubated patients cannot be assessed for the verbal response, which is replaced by “T”. The verbal component (maximum 5) is omitted, so the best total becomes Eye (4) + Motor (6) = 10, and the notation “T” is added, making it 11T. Regular reassessment (every 30 minutes) is crucial to detect changes in neurological status.

Post gastrectomy management

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Q) A 60-year-old woman presents with chronic postprandial epigastric pain, nausea, and bilious vomiting. She had a Billroth II gastrectomy 8 years ago. Despite medical therapy with proton pump inhibitors, sucralfate, and cholestyramine, her symptoms persist. Endoscopy and biopsy confirm ongoing bile reflux gastritis with reactive gastropathy. She is nutritionally declining and has poor quality of life.

What is the most appropriate next step in management?

A. Increase the dose of cholestyramine
B. Add prokinetic therapy (e.g., metoclopramide)
C. Perform total gastrectomy with esophagojejunostomy
D. Convert Billroth II to a Roux-en-Y gastrojejunostomy
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Shock

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Q) A 25-year-old male is brought to the emergency department after a high-speed motorbike accident. He is conscious but reports inability to move his lower limbs. On examination his blood pressure is 75/40 mmHg, pulse 48/min, skin warm and dry. There is flaccid paralysis of both lower limbs and decreased sensation below the level of the umbilicus. Jugular venous pressure is low.

What is the most likely diagnosis?

A. Hypovolemic shock due to occult intra-abdominal bleed
B. Neurogenic shock due to spinal cord injury
C. Cardiogenic shock due to blunt cardiac contusion
D. Septic shock due to aspiration pneumonia
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Retinoblastoma

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Q) Retinoblastoma, the most common ocular malignancy of childhood, has the following features. Which statement is TRUE?

a) It is always unilateral and sporadic
b) Bilateral disease occurs in about one-third of cases
c) It is inherited in an autosomal recessive fashion
d) It is caused by mutation of the p53 gene on chromosome 17

Body response to Trauma

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Q) A 28-year-old male is brought to the ED after a road traffic accident with polytrauma. He undergoes emergency laparotomy for splenic injury. On postoperative day 1, he develops fever (38.7°C), tachycardia (120/min), leukocytosis (18,000/µL), and hypotension requiring fluids. Blood and urine cultures are negative. No evidence of pneumonia is seen on chest X-ray.

Which of the following best explains his condition?
✅ Answer: B. Sterile systemic inflammatory response due to DAMP release

🔍 Explanation:
Trauma and major surgery cause tissue necrosis, ischemia, and cellular injury. Intracellular molecules such as HMGB1, mitochondrial DNA, ATP, uric acid, and heat shock proteins are released and act as DAMPs (damage-associated molecular patterns).

These activate innate immune receptors like Toll-like receptors and inflammasomes (e.g., NLRP3), triggering a robust inflammatory response even in the absence of infection. This explains sterile SIRS, which can mimic sepsis but with negative cultures.

🧠 Key Point: DAMP-driven sterile inflammation is common after trauma, burns, pancreatitis, and ischemia-reperfusion injuries. It must be differentiated from infection-driven SIRS (PAMP-mediated sepsis).
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MEN 1 (click the topic to see answer)

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Premium MCQ - MEN1 Syndrome
Q) A 32-year-old woman presents with fatigue and kidney stones. Labs show:
- Serum calcium: 11.6 mg/dL (elevated)
- PTH: inappropriately elevated
- Serum prolactin: normal
- Fasting glucose: elevated, HbA1c: 7.2%
Her brother had a gastrinoma and hyperparathyroidism in his 30s.
A MEN1 mutation is detected on genetic testing.

Which of the following is the most appropriate next step in her evaluation?
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TIPS

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Q: A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?

A) Serum bilirubin of 3.5 mg/dL
B) MELD score of 18
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
D) History of prior hepatic encephalopathy controlled on lactulose