NEET-PG 2013 Practice Questions

Q: Which nerve does NOT carry referred ear pain?

Abducens nerve. ***Abducens nerve*** - The **abducens nerve (CN VI)** primarily controls the **lateral rectus muscle** of the eye, responsible for **abduction of the eyeball**. - It has **no sensory function** and, therefore, cannot carry referred pain from any region, including the ear. *Trigeminal nerve* - The **trigeminal nerve (CN V)**, particularly its **auriculotemporal branch**, provides sensory innervation to part of the external ear and temporomandibular joint, making it a common pathway for **referred otalgia** from dental or TMJ issues. - Pain from conditions like **trigeminal neuralgia**, **TMJ disorders**, or **dental caries** can be referred to the ear via this nerve. *Glossopharyngeal nerve* - The **glossopharyngeal nerve (CN IX)** supplies sensory innervation to the **middle ear**, pharynx, and posterior tongue. - Conditions affecting these areas, such as **glossopharyngeal neuralgia**, **tonsillitis**, or **pharyngitis**, can cause **referred ear pain**. *Vagus nerve* - The **vagus nerve (CN X)**, specifically the **auricular branch (Arnold's nerve)**, provides sensory innervation to a portion of the external auditory canal and concha. - Irritation of this nerve from conditions in the **larynx**, **pharynx**, **esophagus**, or **heart** can lead to referred ear pain.

Q: Site of glomus jugulare tumor?

Hypotympanum. ***Hypotympanum*** - **Glomus jugulare tumor** is a paraganglioma arising from the **paraganglia** (chemoreceptor cells) located in the **adventitia of the jugular bulb** in the **jugular foramen**. - This anatomical location places the tumor in the **hypotympanum** (inferior compartment of the middle ear cavity), which lies directly above the jugular bulb [1]. - These tumors typically present with **pulsatile tinnitus**, **hearing loss**, and a **reddish-blue mass** behind the tympanic membrane (rising sun sign). - The hypotympanum extends from the floor of the middle ear to the level of the inferior margin of the tympanic membrane [1]. *Epitympanum* - The **epitympanum** (attic) is the **superior compartment** of the middle ear, located above the tympanic membrane [1]. - It contains the head of the **malleus** and body of the **incus** [1]. - **Glomus tympanicum tumors** (arising from paraganglia along the tympanic plexus on the promontory) may present here, but glomus jugulare tumors originate inferiorly in the hypotympanum. *Mesotympanum* - The **mesotympanum** is the **middle compartment** of the middle ear, at the level of the tympanic membrane. - It contains the **manubrium of malleus** and **long process of incus**. - While glomus jugulare tumors may extend into this region as they grow, their primary site of origin is the hypotympanum. *Internal ear* - The **internal ear** (inner ear) is located medial to the middle ear and contains the **cochlea**, **vestibule**, and **semicircular canals** [1]. - Advanced glomus jugulare tumors may erode into the inner ear causing **sensorineural hearing loss** and **vertigo**, but this is not their site of origin.

Q: What is the expected Transtubular Potassium Gradient (TTKG) in a patient with hypokalemia due to extrarenal losses?

< 3-4. ***< 3-4*** - A **Transtubular Potassium Gradient (TTKG)** of less than 3-4 indicates appropriate renal potassium conservation in response to hypokalemia. - This suggests that the hypokalemia is likely due to **extrarenal losses**, such as gastrointestinal losses (diarrhea, vomiting) or inadequate dietary intake, as the kidneys are working to retain potassium. *3-4* - A TTKG value in this range is typically considered indeterminate but could still point towards appropriate renal conservation if other clinical signs of extrarenal losses are present. - However, it does not as strongly confirm appropriate renal conservation as a value clearly below 3. *> 4-5* - A TTKG greater than 4-5 suggests **inappropriate renal potassium excretion** for a patient with hypokalemia. - This would indicate that the kidneys are complicit in the potassium loss, pointing towards renal causes of hypokalemia, such as **mineralocorticoid excess** or **diuretic use**. *> 5-6* - A TTKG greater than 5-6 strongly indicates significant **renal potassium wasting**. - This would be seen in conditions where the kidneys are actively secreting potassium despite hypokalemia, thereby contributing to the low potassium levels rather than conserving it.

Q: Which of the following is associated with WPW syndrome?

Ebstein anomaly. ***Ebstein anomaly*** - **Ebstein anomaly** is a congenital heart defect characterized by apical displacement of the septal and posterior leaflets of the tricuspid valve, which is strongly associated with **Wolff-Parkinson-White (WPW) syndrome.** - WPW syndrome, involving an **accessory pathway** that bypasses the AV node [1], is found in 5-25% of patients with Ebstein anomaly, predisposing them to re-entrant tachycardias [3]. *TOF* - **Tetralogy of Fallot (TOF)** is a complex cyanotic congenital heart defect that includes four main features: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [2]. - There is no direct or strong association between TOF and WPW syndrome. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect where there is an opening in the interventricular septum, allowing blood to flow between the ventricles [4]. - While VSDs can occur with other cardiac anomalies, there is no specific or frequent association with WPW syndrome. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a rare congenital heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - This condition does not have a recognized association with WPW syndrome.

Q: Most common cause of kyphotic deformity ?

Osteoporosis. ***Osteoporosis*** - **Osteoporosis** leads to vertebral compression fractures, particularly in the thoracic spine, which causes a gradual collapse of the vertebral bodies and an increase in the kyphotic curve. - This condition is very common, especially in **postmenopausal women** and the elderly, making it the most frequent cause of kyphotic deformity. *Trauma* - While significant **spinal trauma** can lead to kyphotic deformities, it is generally less common than the gradual kyphosis resulting from osteoporosis. - Traumatic kyphosis usually results from severe injuries leading to **vertebral body collapse** or neurological deficits. *Ankylosing spondylitis* - **Ankylosing spondylitis** can cause severe kyphosis, often referred to as a "bamboo spine," due to chronic inflammation and fusion of the vertebrae. - However, it is a less prevalent condition compared to **osteoporosis-related kyphosis**. *Rickets* - **Rickets**, a childhood bone disorder caused by **vitamin D deficiency**, can lead to bone deformities including kyphosis due to softened bones. - While a cause in children, its prevalence is lower than osteoporosis globally as a cause of kyphosis and it primarily affects a different age group.

Q: Which of the following movements is typically restricted in Perthes disease?

Abduction & internal rotation. ***Abduction & internal rotation*** - **Perthes disease** affects the femoral head, leading to pain and stiffness that most commonly restricts **abduction** and **internal rotation** of the hip. - This restriction is an early and consistent clinical finding, often accompanied by a ** Trendelenburg gait** due to gluteal muscle weakness or pain avoidance. *Abduction & external rotation* - While abduction can be restricted, a primary restriction in **external rotation** is less typical in early Perthes disease. - Reduced external rotation is more characteristic of conditions like **slipped capital femoral epiphysis (SCFE)**, especially in older children. *Adduction & internal rotation* - **Adduction** is generally preserved or even increased in Perthes disease as the hip seeks a position of comfort due to pain, making it an unlikely primary restriction. - While internal rotation is restricted, the combination with adduction restriction is not the classical presentation. *Adduction & external rotation* - Neither **adduction** nor **external rotation** are typically the primary hip movements restricted in Perthes disease. - Restriction in adduction is rare, and external rotation is often compensatory or less affected than internal rotation.

Q: Which of the following is a premalignant lesion for carcinoma of the rectum?

Adenomatous polyps. ***Adenomatous polyps*** - **Adenomatous polyps** are the classic premalignant lesions that progress to colorectal carcinoma through the well-established **adenoma-carcinoma sequence**. - These polyps contain **dysplastic epithelium** with potential for malignant transformation, making them the most important precursor lesion for rectal cancer. *Juvenile polyposis* - **Juvenile polyps** are hamartomatous lesions that are generally **benign** and rarely undergo malignant transformation. - They lack the **dysplastic changes** characteristic of true premalignant lesions and do not follow the adenoma-carcinoma pathway. *Familial adenomatous polyposis* - **FAP** is a **hereditary syndrome** characterized by hundreds to thousands of adenomatous polyps, not a single discrete premalignant lesion. - While FAP patients develop rectal cancer due to the numerous **adenomatous polyps** they harbor, FAP itself is the syndrome rather than the individual premalignant lesion. *Hyperplastic polyps* - **Hyperplastic polyps** are non-neoplastic lesions composed of **mature epithelial cells** without dysplasia. - They have **minimal malignant potential** and are not considered true premalignant lesions for colorectal carcinoma.

Q: In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?

6 hr. ***6 hr*** - Testicular viability is highest when **detorsion** occurs within **6 hours** of symptom onset. - Delay beyond this timeframe significantly increases the risk of **testicular ischemia** and necrosis. *12 hr* - While some viability may remain, the probability of **testicular salvage** decreases substantially after 6 hours. - Testicular function, including **sperm production**, is often compromised even if the testis is saved. *24 hr* - Beyond 12-24 hours, the likelihood of **testicular viability** is very low, and **orchiectomy** (testicle removal) is often necessary. - Prolonged ischemia leads to irreversible **tissue damage** and infarction. *1 week* - After one week, the testis is almost certainly non-viable due to **prolonged ischemia** and necrosis. - This delay would invariably result in the need for **orchiectomy**.

Q: A 55-year-old male presents with a history of dysphagia with vomiting of undigested food throughout the day, weight loss, and appears emaciated and dehydrated. No mass is palpable per abdomen. After appropriate diagnostic workup reveals a benign esophageal stricture, the most appropriate definitive management is:

Endoscopic dilation. ***Endoscopic dilation (preferred treatment)*** - **Endoscopic dilation** directly addresses the underlying problem of the **benign esophageal stricture** by widening the narrowed esophagus, which is crucial for relieving dysphagia and improving nutritional intake. - Given the patient's severe symptoms like **weight loss**, **emaciation**, and **dehydration**, dilation allows for symptom relief and subsequent rehydration and nutritional support. *IV total parenteral nutrition* - While TPN provides nutrition, it does not resolve the **mechanical obstruction** caused by the stricture and carries risks such as infection and metabolic complications. - It's typically reserved for situations where enteral feeding is not possible or adequate after addressing the obstruction. *IV normal saline* - **IV normal saline** would help address the immediate **dehydration**, but it does not treat the underlying cause of the patient's symptoms (the esophageal stricture). - This is a supportive measure, not the primary management strategy for the stricture itself. *pH monitoring* - **pH monitoring** is used to diagnose and assess gastroesophageal reflux disease (**GERD**), which can sometimes cause strictures. - However, in a patient with a confirmed benign esophageal stricture and severe obstructive symptoms, addressing the stricture mechanically (dilation) takes precedence over diagnostic testing for reflux.

Question 1

Which nerve does NOT carry referred ear pain?

Accepted Answer

Abducens nerve

Answer

Glossopharyngeal nerve

Answer

Vagus nerve

Answer

Trigeminal nerve

Question 2

Site of glomus jugulare tumor?

Accepted Answer

Hypotympanum

Answer

Epitympanum

Answer

Mesotympanum

Answer

Internal ear

Question 3

What is the expected Transtubular Potassium Gradient (TTKG) in a patient with hypokalemia due to extrarenal losses?

Accepted Answer

< 3-4

Answer

3-4

Answer

> 4-5

Answer

> 5-6

Question 4

Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?

Accepted Answer

A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation.

Answer

A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.

Answer

Residual Volume (RV) is normal.

Answer

Total Lung Capacity (TLC) is decreased.

Question 5

Which of the following is associated with WPW syndrome?

Accepted Answer

Ebstein anomaly

Answer

TOF

Answer

VSD

Answer

TAPVC

Question 6

Most common cause of kyphotic deformity ?

Accepted Answer

Osteoporosis

Answer

Trauma

Answer

Ankylosing spondylitis

Answer

Rickets

Question 7

Which of the following movements is typically restricted in Perthes disease?

Accepted Answer

Abduction & internal rotation

Answer

Abduction & external rotation

Answer

Adduction & internal rotation

Answer

Adduction & external rotation

Question 8

Which of the following is a premalignant lesion for carcinoma of the rectum?

Accepted Answer

Adenomatous polyps

Answer

Juvenile polyposis

Answer

Familial adenomatous polyposis

Answer

Hyperplastic polyps

Question 9

In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?

Accepted Answer

6 hr

Answer

12 hr

Answer

24 hr

Answer

1 week

Question 10

A 55-year-old male presents with a history of dysphagia with vomiting of undigested food throughout the day, weight loss, and appears emaciated and dehydrated. No mass is palpable per abdomen. After appropriate diagnostic workup reveals a benign esophageal stricture, the most appropriate definitive management is:

Accepted Answer

Endoscopic dilation

Answer

IV normal saline

Answer

pH monitoring

Answer

IV total parenteral nutrition

NEET-PG 2013

Anatomy

ENT

Internal Medicine

Orthopaedics

Pathology

Surgery