NEET SS practise tests

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

Malignancy risk in Stem cells

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Q: Risk of malignancy is highest with which stem cells?

# Bailey Chapter 4

a) Somatic cells
b) SSc
c) Fetal cells
d) All
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Parkland formula

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Q )  During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given in first 8 hours is ?
A. 50%
B. 25 % 
C. 75 % 
D. 100 % 

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Ans a

The modified Parkland formula

TBSA% burn × weight (kg) × 4 = volume in mL
The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.

Developed by Dr. Charles Baxter in the 1960s at the Parkland Memorial Hospital in Texas, this formula serves as a cornerstone in determining the initial fluid requirements to stabilize burn victims during the crucial early hours following injury.

Although the Parkland Formula offers a valuable framework for fluid resuscitation, it's important to note that individual patient variability, coexisting injuries, and evolving clinical conditions necessitate close monitoring and adjustment of the resuscitation plan. Over-resuscitation can lead to complications such as pulmonary edema, while under-resuscitation can result in inadequate tissue perfusion and organ failure.

Bailey 28th  671