NEET-PG 2013 Practice Questions

Q: Which are the second order neurons in the optic pathway?

Bipolar cells. ***Bipolar cells*** - **Photoreceptors** (rods and cones) are first-order neurons, sensing light. [1] - **Bipolar cells** receive input from photoreceptors and transmit signals to retinal ganglion cells, acting as second-order neurons. [1] *Ganglionic cells* - **Ganglion cells** are third-order neurons in the visual pathway. [1] - Their axons form the **optic nerve**, which carries visual information to the brain. [2] *Cells of lateral geniculate body* - The **lateral geniculate nucleus (LGN)** of the thalamus contains fourth-order neurons. [1] - These cells project to the primary visual cortex. [2] *Astrocytes* - **Astrocytes** are a type of glial cell that provides support and protection to neurons in the central nervous system. - They are **not directly involved** in the transmission of visual information in the optic pathway.

Q: Which of the following conditions is associated with objective tinnitus?

Glomus tumor. ***Glomus tumor*** - A glomus tumor is a **vascular tumor** that can cause turbulent blood flow, leading to a pulsatile, objective tinnitus that can be heard by an examiner. - The sound is often described as a **thumping or whooshing** sound synchronous with the patient's heartbeat. *Ménière's disease* - **Ménière's disease** is associated with subjective tinnitus, a ringing or roaring sensation perceptible only to the patient. - It is characterized by the triad of **vertigo, fluctuating hearing loss, and tinnitus**. *Acoustic neuroma* - An acoustic neuroma (vestibular schwannoma) typically causes **unilateral, subjective tinnitus**, often described as a high-pitched ringing. - It is a benign tumor on the **vestibulocochlear nerve** and is also associated with sensorineural hearing loss and balance issues. *Ear wax* - **Impacted ear wax** can cause subjective tinnitus due to its interference with sound conduction and resonance within the ear canal. - The tinnitus is not typically audible to an examiner, making it a **subjective finding**.

Q: Hyponasal voice is seen in all except?

Cleft lip. ***Cleft lip*** - A **cleft lip** primarily affects the appearance of the lip and a portion of the nose but doesn't typically obstruct the nasal passages to cause a hyponasal voice. - The voice quality in individuals with a cleft lip, without an associated cleft palate, is usually normal. *Adenoids* - **Enlarged adenoids** can obstruct the nasopharyngeal airway, leading to reduced nasal resonance and a **hyponasal (rhinolalia clausa)** voice. - This obstruction prevents air from exiting through the nose during speech, making sounds like 'm' and 'n' sound like 'b' and 'd'. *Nasal polyp* - **Nasal polyps** can physically block the nasal passages, impairing airflow through the nose during speech. - This blockage leads to a reduction in nasal resonance, resulting in a **hyponasal voice**. *Deviated nasal septum* - A **deviated nasal septum** can significantly narrow one or both nasal passages, restricting airflow. - This structural obstruction can cause a **hyponasal voice** due to reduced nasal resonance.

Q: What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

Modified radical mastoidectomy. ***Modified radical mastoidectomy*** - The **atticoantral type of CSOM** is characterized by active **cholesteatoma**, which requires surgical removal to prevent further bone erosion and complications. - A **modified radical mastoidectomy** is the treatment of choice as it removes the cholesteatoma and diseased mastoid air cells while aiming to preserve residual hearing. *Antibiotics* - While topical or systemic antibiotics may be used to control acute infections or discharge in CSOM, they do not eradicate **cholesteatoma**. - **Cholesteatoma** is an epidermoid cyst that requires surgical excision, as antibiotics alone cannot resolve it. *Tympanoplasty* - **Tympanoplasty** is primarily performed to reconstruct the tympanic membrane (eardrum) and/or the ossicular chain to restore hearing. - It is typically indicated for the **tubotympanic type of CSOM** (safe type) without cholesteatoma, not for the atticoantral type which involves cholesteatoma. *None of the options* - This option is incorrect because **modified radical mastoidectomy** is a well-established and necessary treatment for the atticoantral type of CSOM involving cholesteatoma.

Q: Interstitial nephritis is common with

Nonsteroidal anti-inflammatory drugs (NSAIDs). ***Nonsteroidal anti-inflammatory drugs (NSAIDs)*** - **NSAIDs** are a known cause of **acute interstitial nephritis** (AIN), an inflammatory condition affecting the tubules and interstitium of the kidney [1]. - This adverse reaction often manifests as **fever**, **rash**, **eosinophilia**, and **acute kidney injury**, typically 7-10 days after drug exposure. *Black water fever* - **Blackwater fever** is a severe complication of **malaria**, characterized by massive hemolysis leading to **hemoglobinuria**, which darkens the urine. - It primarily causes **acute kidney injury** through **acute tubular necrosis** due to hemoglobin precipitation in the renal tubules, not interstitial nephritis. *Rhabdomyolysis* - **Rhabdomyolysis** involves the breakdown of muscle tissue, releasing myoglobin into the bloodstream, which is toxic to the kidneys. [1] - This condition leads to **acute kidney injury** predominantly through **acute tubular necrosis** due to myoglobin casts obstructing tubules and direct toxicity, not interstitial inflammation. *Tumor lysis syndrome* - **Tumor lysis syndrome** occurs when large numbers of cancer cells are rapidly destroyed, releasing intracellular contents like potassium, phosphate, and nucleic acids. - The high concentration of **uric acid** and **phosphate** in the renal tubules leads to crystal formation, causing **acute kidney injury** primarily through **acute uric acid nephropathy** and **phosphate nephropathy**, rather than interstitial nephritis [1].

Q: The most common cause of vitreous hemorrhage in adults is

Diabetes. ***Diabetes*** - **Proliferative diabetic retinopathy (PDR)** leads to the formation of new, fragile blood vessels (neovascularization) on the retinal surface or optic disc. - These new vessels are prone to bleeding into the **vitreous cavity**, making diabetes the most common cause of vitreous hemorrhage in adults. *Retinal hole* - A retinal hole or tear can lead to **rhegmatogenous retinal detachment** but does not commonly cause significant vitreous hemorrhage on its own. - While a tear can sometimes be associated with a small amount of hemorrhage, it is not the MOST common cause of widespread vitreous bleeding. *Trauma* - **Ocular trauma**, such as blunt or penetrating injuries, can certainly cause vitreous hemorrhage due to direct damage to retinal or choroidal blood vessels. - However, in the general adult population, **systemic diseases** like diabetes are statistically more frequent causes of spontaneous vitreous hemorrhage than acute trauma. *Hypertension* - Severe **hypertensive retinopathy** can cause retinal hemorrhages, microaneurysms, and cotton wool spots, but it typically does not lead to large-volume vitreous hemorrhage. - While hypertension can contribute to the severity of other retinal conditions, it is not the primary direct cause of vitreous hemorrhage itself.

Q: Most significant risk factor for development of gastric carcinoma is

Intestinal metaplasia. ***Intestinal metaplasia*** - **Intestinal metaplasia** is a precursor lesion where gastric epithelium is replaced by intestinal-type epithelium, significantly increasing the risk for **gastric carcinoma** [1][2]. - It is a recognized **high-risk factor**, especially in cases of chronic gastritis and atrophic changes in the stomach lining [1][2]. *Ciliated metaplasia* - This condition is generally associated with **respiratory epithelium** and is not linked to gastric carcinoma risk. - It does not involve gastric epithelial changes, therefore, it does not influence **gastric cancer development**. *Pyloric metaplasia* - Pyloric metaplasia typically occurs in chronic gastritis but does not confer a significant **risk** of gastric carcinoma. - It is more related to gastric mucosa adaptation and does not show the same risk association as **intestinal metaplasia**. *Paneth cell metaplasia* - Paneth cell metaplasia is primarily seen in **intestinal disorders** and does not serve as an indicator for gastric carcinoma. - It does not reflect changes in gastric epithelium that are related to cancer risk in the stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 777-778. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 354-355.

Q: Steroids are injurious to wound healing when administered during which time frame?

Within 2 weeks. ***Within 2 weeks*** - Steroids administered **within the first 2 weeks** of wound healing significantly impair the **inflammatory and proliferative phases**, crucial for new tissue formation. - This early disruption can lead to **decreased collagen synthesis**, reduced wound contraction, and increased risk of **dehiscence**. *On the first day* - While steroids can affect the very early inflammatory response, the most detrimental impact on overall wound healing processes, particularly **collagen deposition**, occurs over a slightly longer initial period. - The effects of a single dose on day one might be less pronounced than sustained steroid exposure during the more critical **proliferative phase**. *2-4 weeks* - By this stage, the wound is typically in the **remodeling phase**, where collagen fibers are being reorganized and strengthened. - While steroids can still mildly affect healing, their **most damaging effects** on crucial initial processes have usually passed. *> 4 weeks* - Beyond 4 weeks, the wound is generally well into the **remodeling or maturation phase**, and often has achieved significant tensile strength. - Steroid administration at this stage would have **minimal impact** on the overall structural integrity of the healed wound, although chronic steroid use has systemic effects.

Q: Which of the following is NOT a feature of Cushing's triad?

Hypotension. ***Hypotension*** - Cushing's triad is an indicator of **increased intracranial pressure (ICP)** and classically presents with **hypertension**, not hypotension. - Hypotension would suggest a different problem, such as **spinal shock** or **hypovolemia**, which are not directly associated with Cushing's triad. *Bradycardia* - **Bradycardia** is a key component of Cushing's triad, resulting from vagal stimulation due to increased intracranial pressure. - This reflex reduces heart rate in an attempt to maintain cerebral perfusion. *Hypertension* - **Hypertension**, specifically a widened pulse pressure, is a cardinal feature of Cushing's triad, caused by systemic vasoconstriction to overcome increased ICP and maintain **cerebral perfusion pressure**. - It is a compensatory mechanism to push blood into the brain. *Irregular breathing* - **Irregular breathing patterns**, such as Cheyne-Stokes respiration or ataxic breathing, are characteristic of Cushing's triad, indicating brainstem compression [1]. - This irregular respiratory effort is due to direct pressure on the **respiratory centers** in the medulla [1].

Q: Among the following single parameters, malnutrition in surgical patients is best assessed by:

Mid arm circumference. ***Mid arm circumference*** - **Mid-arm circumference (MAC)** is considered a reliable and easily measurable single parameter for assessing malnutrition, as it reflects both **muscle mass** and **subcutaneous fat**. - It is particularly useful in surgical patients where rapid and practical assessment of nutritional status is needed. *Serum albumin* - While **serum albumin** reflects visceral protein status, its levels can be significantly affected by **hydration status**, inflammation, and liver disease, making it less specific for malnutrition in acute surgical settings. - Due to its **long half-life**, serum albumin may not accurately reflect recent changes in nutritional status. *Hb level* - **Hemoglobin (Hb) levels** primarily assess anemia, which can be caused by various factors beyond malnutrition, such as blood loss or chronic disease. - Anemia does not directly measure or reflect overall protein-energy malnutrition. *Triceps skin fold thickness* - **Triceps skin fold thickness (TSFT)** measures subcutaneous fat stores but does not provide information about lean muscle mass or overall protein status. - Its measurement can be less accurate due to inter-observer variability and may not reflect comprehensive malnutrition as well as MAC.

Question 1

Which are the second order neurons in the optic pathway?

Accepted Answer

Bipolar cells

Answer

Ganglionic cells

Answer

Cells of lateral geniculate body

Answer

Astrocytes

Question 2

Which of the following conditions is associated with objective tinnitus?

Accepted Answer

Glomus tumor

Answer

Acoustic neuroma

Answer

Ear wax

Answer

Ménière's disease

Question 3

Hyponasal voice is seen in all except?

Accepted Answer

Cleft lip

Answer

Adenoids

Answer

Nasal polyp

Answer

Deviated nasal septum

Question 4

What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?

Accepted Answer

Modified radical mastoidectomy

Answer

Tympanoplasty

Answer

None of the options

Answer

Antibiotics

Question 5

Interstitial nephritis is common with

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer

Black water fever

Answer

Rhabdomyolysis

Answer

Tumor lysis syndrome

Question 6

The most common cause of vitreous hemorrhage in adults is

Accepted Answer

Diabetes

Answer

Retinal hole

Answer

Trauma

Answer

Hypertension

Question 7

Most significant risk factor for development of gastric carcinoma is

Accepted Answer

Intestinal metaplasia

Answer

Pyloric metaplasia

Answer

Ciliated metaplasia

Answer

Paneth cell metaplasia

Question 8

Steroids are injurious to wound healing when administered during which time frame?

Accepted Answer

Within 2 weeks

Answer

2-4 weeks

Answer

> 4 weeks

Answer

On the first day

Question 9

Which of the following is NOT a feature of Cushing's triad?

Accepted Answer

Hypotension

Answer

Hypertension

Answer

Bradycardia

Answer

Irregular breathing

Question 10

Among the following single parameters, malnutrition in surgical patients is best assessed by:

Accepted Answer

Mid arm circumference

Answer

Triceps skin fold thickness

Answer

Hb level

Answer

Serum albumin

NEET-PG 2013

Anatomy

ENT

Internal Medicine

Ophthalmology

Pathology

Surgery