NEET-PG 2013 Practice Questions

Q: Which structure prevents spread of infection from middle ear to brain?

Tegmen tympani. ***Tegmen tympani*** - The **tegmen tympani** is a thin plate of bone forming the roof of the middle ear cavity, separating it from the **middle cranial fossa** and the brain. - Its primary function is to act as a **bony barrier**, preventing upward spread of infection from the middle ear space into the intracranial cavity. *Cribriform plate* - The **cribriform plate** is part of the ethmoid bone, located in the anterior cranial fossa, and is perforated by the **olfactory nerves**. - It does not form a boundary to the middle ear cavity and is not involved in preventing infection spread from the middle ear. *Fundus tympani* - This term is not a standard anatomical landmark. The **floor of the tympanic cavity**, or **fundus tympani**, separates the middle ear from the **internal jugular vein**. - It does not prevent the spread of infection to the brain but rather to structures below the middle ear. *Petrous apex* - The **petrous apex** is the very tip of the petrous part of the temporal bone, which houses the cochlea and vestibule. - While part of the temporal bone, it is not the direct barrier between the middle ear cavity and the brain; its involvement in infection spread is typically due to **petrous apexitis**, a distinct complication.

Q: Lymphatic drainage of oropharynx is mainly through?

Jugulodigastric node. ***Jugulodigastric node*** - The **jugulodigastric node** (also known as the principal node of Küttner) is the primary drainage site for infections and malignancies of the posterior third of the tongue and tonsils, which are key components of the oropharynx. - It is a prominent node within the **deep cervical lymph node** chain, specifically located in the superior deep cervical group. *Superficial cervical lymph nodes* - These nodes primarily drain the superficial structures of the neck, scalp, and ear, and are **not the main drainage pathway** for the oropharynx. - They form a chain along the external jugular vein. *Submandibular nodes* - The **submandibular nodes** mainly drain the anterior two-thirds of the tongue, gums, floor of the mouth, and anterior face. - While part of the oral cavity, they are **not the primary drainage** for the oropharynx itself. *Jugulo-omohyoid nodes* - The **jugulo-omohyoid node** is located lower in the deep cervical chain, near the intermediate tendon of the omohyoid muscle. - It is a key drainage node for the **anterior tongue**, but not the primary or main drainage for the entire oropharynx.

Q: Most common sinus to be involved in acute sinusitis?

Maxillary. ***Maxillary*** - The **maxillary sinuses** are the largest paranasal sinuses and are the most commonly involved in acute sinusitis due to their anatomical position and drainage characteristics. - Their ostia (drainage openings) are located on the superior aspect of the sinus, which can make drainage difficult when the patient is upright, leading to stasis of secretions and increased susceptibility to infection. *Ethmoid* - The ethmoid sinuses are a group of small air cells located between the eyes and are the second most commonly infected in sinusitis. - While frequently involved, especially in children, they are not as commonly affected as the maxillary sinuses in the general adult population with acute sinusitis. *Sphenoid* - The sphenoid sinuses are located deep within the skull, behind the eyes, and are the least commonly involved in acute sinusitis. - Inflammation here can be serious due to proximity to important structures like the optic nerves and carotid arteries, but it's not the most frequent site of infection. *Frontal* - The frontal sinuses are located in the forehead and are less commonly involved in acute sinusitis compared to the maxillary and ethmoid sinuses. - Their development is not complete until adolescence, and they are typically drained via the frontonasal duct, which can become easily obstructed.

Q: A diabetic patient presents with sensory involvement, tingling, numbness, ankle swelling, and absence of pain. What is the most likely diagnosis?

Charcot's joint. ***Charcot's joint*** - This condition is characterized by **neuropathic arthropathy**, resulting from nerve damage (often due to **diabetes**), leading to sensory involvement, **numbness**, and **absence of pain** [1]. - The loss of protective sensation and repeated microtrauma contribute to joint destruction, often manifesting as **swelling** and deformity, particularly in the feet and ankles [1]. *Gout* - Gout typically presents with sudden, severe episodes of **pain**, redness, and swelling in a single joint, most commonly the **big toe**. - It is caused by **uric acid crystal deposition** and is not primarily associated with sensory deficits or chronic painless swelling. *Rheumatoid arthritis* - This is a **chronic autoimmune** inflammatory disease primarily affecting the **small joints** of the hands and feet symmetrically, causing pain, stiffness, and swelling. - It does not typically present with sensory neuropathy or painless joint destruction in the way described. *Ankylosing spondylitis* - This is a **chronic inflammatory disease** primarily affecting the **spine and sacroiliac joints**, causing progressive stiffness and pain that improves with activity. - It is not associated with peripheral joint neuropathy, numbness, or painless ankle swelling [1].

Q: Which agent is known to cause corneal ulcers that may resemble fungal infections?

Nocardia asteroides. ***Nocardia asteroides*** - This organism can cause **Nocardia keratitis**, which often presents with a **feathery or crystalline appearance** in the cornea, mimicking a fungal infection. - It tends to occur in patients with **contact lens use** or ocular trauma and requires specific antimicrobial treatment different from fungal therapy. *Mycobacterium* - **Atypical mycobacteria** can cause chronic, indolent corneal ulcers, particularly after trauma or surgery. - While they can be challenging to diagnose, their appearance typically differs from the **feathery morphology** associated with fungal or Nocardia infections. *Klebsiella pneumoniae* - **Klebsiella pneumoniae** is a common cause of **bacterial keratitis**, especially in contact lens wearers. - Infections usually manifest as a rapidly progressing infiltrate with significant inflammation and often produce abundant **mucopurulent discharge**, not typically mistaken for fungal infections. *Chlamydia trachomatis* - **Chlamydia trachomatis** is the causative agent of **trachoma**, leading to recurrent conjunctivitis and eventually corneal scarring and blindness in endemic areas. - It does not cause acute corneal ulcers that resemble fungal infections; rather, it results in a chronic inflammatory process with **follicular conjunctivitis** and **pannus formation**.

Q: What is the first-line treatment for acute angle closure glaucoma?

Acetazolamide. **Acetazolamide** - **Acetazolamide** (oral or intravenous) is a carbonic anhydrase inhibitor that rapidly reduces intraocular pressure by decreasing aqueous humor production, making it the **first-line medical treatment** for acute angle-closure glaucoma. - While other agents are used, acetazolamide provides the quickest and most significant initial reduction in **intraocular pressure (IOP)**, which is crucial in preventing permanent vision loss. *IV mannitol* - **Intravenous mannitol** is an osmotic diuretic used to draw fluid from the vitreous humor to lower **IOP** significantly, but it is typically reserved for cases where **acetazolamide** alone is insufficient or for very high **IOPs**. - It is often considered a second-line or adjunctive agent rather than the initial first-line treatment. *Pilocarpine* - **Pilocarpine** is a miotic agent that constricts the pupil, which helps to pull the iris away from the trabecular meshwork and open the angle. - However, it should only be administered *after* the **intraocular pressure** has been significantly lowered (e.g., with acetazolamide), as it can worsen angle closure in an inflamed eye with very high **IOP**. *Beta blocker eyedrops* - **Topical beta-blockers** (e.g., timolol) reduce **IOP** by decreasing aqueous humor production and are a common treatment for various types of glaucoma. - While useful in acute angle-closure glaucoma, they act more slowly than **acetazolamide** and are typically used as an adjunct rather than the sole initial first-line treatment.

Q: Which of the following is NOT a feature of CMV retinitis?

Cracked mud appearance. ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.

Q: All are true about carcinoma penis except which of the following?

Spreads by blood borne metastasis. ***Spreads by blood borne metastasis*** - Carcinoma penis typically spreads initially via the **lymphatic system** to inguinal lymph nodes. - **Hematogenous spread** is a late event and generally rare, with the most common sites being the lung, liver, and bone. *Leads to erosion of artery* - Local advancement of penile carcinoma can lead to **erosion of penile arteries**, which can cause significant morbidity including bleeding and functional compromise. - This local tissue destruction is a characteristic feature of advanced, uncontrolled penile cancer. *Slowly progressive* - Carcinoma penis is generally a **slowly progressive** malignancy, allowing for early detection and intervention if patients seek medical attention promptly. - The slow growth rate contributes to the fact that many patients present with localized or regionally advanced disease before distant metastases occur. *Most common type is squamous cell carcinoma* - Approximately 95% of penile cancers are **squamous cell carcinomas (SCCs)**, arising from the epithelial cells of the glans or foreskin. - Other rare types include melanoma, basal cell carcinoma, and sarcomas, but SCC vastly predominates.

Q: Most common anomaly of upper urogenital tract is -

Uretero pelvic junction stenosis. ***Uretero pelvic junction stenosis*** - **Ureteropelvic junction (UPJ) obstruction** is the most common cause of **antenatally detected hydronephrosis**, making it the most frequent anomaly of the upper urogenital tract. - It results from an intrinsic or extrinsic narrowing at the junction of the **renal pelvis** and the **ureter**, impeding urine flow. *Ectopic urethral opening* - This anomaly involves the **urethral opening** being in an abnormal location, such as **hypospadias** or **epispadias** in males, or into the vagina in females. - While relatively common, it is an anomaly of the **lower urogenital tract**, specifically the urethra, not the upper tract. *Ureterocele* - A ureterocele is a **cystic dilation** of the distal part of the ureter as it enters the bladder. - While it can be associated with varying degrees of **upper tract obstruction**, it is not as common as UPJ stenosis. *Ectopic ureter* - An ectopic ureter involves a ureter that drains into an abnormal location other than the **trigone of the bladder**. - This condition is less common than UPJ stenosis and is often associated with a **duplex collecting system**.

Question 1

Which structure prevents spread of infection from middle ear to brain?

Accepted Answer

Tegmen tympani

Answer

Cribriform plate

Answer

Fundus tympani

Answer

Petrous apex

Question 2

Lymphatic drainage of oropharynx is mainly through?

Accepted Answer

Jugulodigastric node

Answer

Superficial cervical lymph nodes

Answer

Submandibular nodes

Answer

Jugulo-omohyoid nodes

Question 3

Most common sinus to be involved in acute sinusitis?

Accepted Answer

Maxillary

Answer

Ethmoid

Answer

Sphenoid

Answer

Frontal

Question 4

A diabetic patient presents with sensory involvement, tingling, numbness, ankle swelling, and absence of pain. What is the most likely diagnosis?

Accepted Answer

Charcot's joint

Answer

Gout

Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Question 5

Which agent is known to cause corneal ulcers that may resemble fungal infections?

Accepted Answer

Nocardia asteroides

Answer

Mycobacterium

Answer

Klebsiella pneumoniae

Answer

Chlamydia trachomatis

Question 6

All statements are true about trachoma except:

Accepted Answer

Marked papillary hyperplasia with limbal follicles are seen in stage III

Answer

Strains mainly responsible are A, B, Ba and C

Answer

Trachoma is caused by bedsonian organism of psittacosis - lymphogranuloma - trachoma (PLT) group.

Answer

Corneal ulceration is a complication

Question 7

What is the first-line treatment for acute angle closure glaucoma?

Accepted Answer

Acetazolamide

Answer

Pilocarpine

Answer

Beta blocker eyedrops

Answer

IV mannitol

Question 8

Which of the following is NOT a feature of CMV retinitis?

Accepted Answer

Cracked mud appearance

Answer

Perivasculitis

Answer

Brush-fire appearance

Answer

Immunosuppression

Question 9

All are true about carcinoma penis except which of the following?

Accepted Answer

Spreads by blood borne metastasis

Answer

Leads to erosion of artery

Answer

Slowly progressive

Answer

Most common type is squamous cell carcinoma

Question 10

Most common anomaly of upper urogenital tract is -

Accepted Answer

Uretero pelvic junction stenosis

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Ectopic urethral opening

NEET-PG 2013

Anatomy

ENT

Internal Medicine

Ophthalmology

Surgery