NEET-PG 2013 Practice Questions

Q: What is not true about the use of intranasal steroids in nasal polyposis?

Effective in all types of nasal polyps. ***Effective in all types of nasal polyps*** - Intranasal steroids are primarily effective in nasal polyps with an **eosinophilic inflammatory component**, which is the most common type. - They are **not effective in all types** - efficacy is significantly reduced in polyps with **neutrophilic inflammation** or those related to conditions like **cystic fibrosis**, reflecting different underlying pathologies. - This statement is **FALSE**, making it the correct answer to this negation question. *May cause nasal irritation* - **Nasal irritation**, including **burning, stinging**, or **dryness**, is a common local side effect associated with the use of intranasal steroids. - Other local side effects can include **epistaxis** (nosebleeds) and mucosal atrophy, though less common. - This statement is **TRUE**. *Reduce recurrence* - **Intranasal steroids** are crucial in **reducing the recurrence** of nasal polyps after surgical removal. - Their anti-inflammatory action helps to **control the underlying inflammation** that contributes to polyp formation. - This statement is **TRUE**. *Most effective in eosinophilically predominant polyps* - Intranasal steroids primarily target the **eosinophilic inflammatory pathway**, which is characteristic of the majority of **chronic rhinosinusitis with nasal polyps (CRSwNP)**. - While they have **maximal efficacy** in eosinophilic polyps, they may have limited benefit in mixed inflammatory patterns. - Their efficacy is significantly reduced in polyps that are predominantly **neutrophilic** or associated with systemic conditions like **cystic fibrosis**, as these involve different inflammatory mechanisms. - This statement is **TRUE**.

Q: A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?

Early Revascularization with PCI. ***Early Revascularization with PCI*** - The patient presents with **NSTEMI** (ST depression, elevated troponins) and is already on antiplatelet and anticoagulant therapy. **Early revascularization** (ideally within 24 hours for high-risk NSTEMI) is indicated to restore blood flow and prevent further myocardial damage [1]. - Given the patient's history of prior **PCI** and the current NSTEMI presentation, this suggests possible **in-stent restenosis** or progression of coronary artery disease, making revascularization crucial. *Continue conservative management and monitoring of cardiac enzymes and ECG* - While initial conservative management with medications is appropriate, simply continuing monitoring without definitive intervention is insufficient for a **high-risk NSTEMI** patient. - The elevated troponins and ST depression indicate ongoing myocardial injury that requires active management beyond just observation [1]. *Continue conservative management and plan for outpatient follow-up* - This approach is entirely inappropriate for a patient presenting with an **acute coronary syndrome (NSTEMI)**. - Outpatient follow-up is for stable conditions, not for an ongoing cardiac event that requires urgent hospital-based intervention. *Immediate Revascularization with Coronary Angiography* - **Immediate revascularization** (within 90 minutes) is primarily indicated for **STEMI** (ST elevation myocardial infarction). - While coronary angiography will precede PCI, the term "immediate" in this context usually refers to the urgency seen in STEMI; NSTEMI typically warrants "early" rather than "immediate" intervention (within 12-24 hours for high-risk patients like this one) [1].

Q: What is the most common cause of lobar consolidation?

Streptococcus. ***Streptococcus*** - **_Streptococcus pneumoniae_** is the **most common bacterial cause** of community-acquired pneumonia, frequently leading to lobar consolidation. [1] - It often presents with classic symptoms such as **sudden onset of fever**, productive cough with **rusty sputum**, and pleuritic chest pain. [1] *Mycoplasma* - **_Mycoplasma pneumoniae_** typically causes **"walking pneumonia"**, characterized by a more indolent course and often presents with **interstitial infiltrates** rather than dense lobar consolidation. - Though common, it is a less frequent cause of true lobar consolidation compared to _Streptococcus pneumoniae_. *Chlamydia* - **_Chlamydia pneumoniae_** causes atypical pneumonia, similar to _Mycoplasma_, presenting with less severe symptoms and **patchy infiltrates** or **interstitial patterns** rather than lobar consolidation. - It is a common cause of **atypical pneumonia** but not the leading cause of lobar consolidation. *Legionella* - **_Legionella pneumophila_** can cause severe pneumonia with consolidation, but it is **less common overall** than pneumococcal pneumonia. [1] - **Legionnaires' disease** is often associated with exposure to contaminated water sources and may present with **gastrointestinal and neurological symptoms** in addition to respiratory manifestations.

Q: Diagnose the underlying medical disorder based on the ECG changes.

ECG changes due to hypocalcemia. ***ECG changes due to hypocalcemia*** - **Hypocalcemia** characteristically causes a **prolonged QT interval** on the ECG due to delayed repolarization of ventricular myocytes. - This prolongation is primarily due to the lengthening of the **ST segment**, while the T wave itself is usually unchanged. *ECG changes due to hypokalemia* - **Hypokalemia** typically presents with prominent **U waves**, T wave flattening or inversion, and sometimes ST segment depression. - While it can also prolong the QT interval, the primary distinguishing feature is the presence of U waves, which are not mentioned as the main finding. *ECG changes due to hypercalcemia* - **Hypercalcemia** is associated with a **shortened QT interval** on the ECG due to accelerated repolarization. - It can also cause a shortened ST segment and widened QRS complex in severe cases. *ECG changes due to hyperkalemia* - **Hyperkalemia** classically manifests as tall, **peaked T waves**, followed by a prolonged PR interval, widened QRS complex, and eventual sine wave pattern as it worsens. - These changes are distinctly different from the prolonged QT interval seen in hypocalcemia.

Q: Cicatrising trachoma is associated with which stage of the disease?

Stage-3. ***Stage-3*** - **Cicatrising trachoma** corresponds to Stage 3 of the WHO classification for trachoma, characterized by scarring of the conjunctiva. - This stage is marked by the presence of **conjunctival scarring (TS)**, which can lead to further complications. *Stage-1* - Stage 1 is characterized by **trachomatous inflammation, follicular (TF)**, indicating active infection with follicles in the upper tarsal conjunctiva. - It represents the initial, active inflammatory phase and does not involve scarring. *Stage-2* - Stage 2 is characterized by **trachomatous inflammation, intense (TI)**, where there is pronounced inflammation that obscures blood vessels. - While intense inflammation is present, significant scarring has not yet developed at this stage, differentiating it from cicatrising trachoma. *Stage-4* - Stage 4 is characterized by **trachomatous trichiasis (TT)**, where the eyelashes turn inward and rub against the cornea. - This stage is a direct complication of the scarring from Stage 3, leading to corneal damage, rather than the cicatrising stage itself.

Q: Arcuate field defect akin to glaucoma is seen in?

Optic nerve lesion. ***Optic nerve lesion*** - An **arcuate field defect** is a specific pattern of visual field loss that follows the course of nerve fibers in the retina and is characteristic of **optic nerve damage**, similar to what is seen in glaucoma. - This type of defect is due to damage to the **bundle of retinal nerve fibers** that arch above or below the macula, often causing a scotoma (blind spot) that respects the horizontal meridian. - Common causes include **anterior ischemic optic neuropathy (AION)**, **optic neuritis**, and other optic nerve pathologies that affect the nerve fiber layer. *Pituitary adenoma* - A pituitary adenoma typically causes a **bitemporal hemianopsia** due to compression of the optic chiasm. - This visual field defect involves the lateral halves of both visual fields, which is different from an arcuate defect. *Posterior cerebral artery infarct* - An infarct in the posterior cerebral artery typically leads to a **homonymous hemianopsia** (loss of half of the visual field on the same side in both eyes) or a quadrantanopsia. - This type of defect results from damage to the **visual cortex** or optic radiations, not the optic nerve itself in a glaucoma-like pattern. *None of the options* - This is incorrect because **optic nerve lesion** is a valid and correct answer. - Optic nerve pathologies are well-established causes of arcuate field defects similar to those seen in glaucoma.

Q: Most commonly recommended cast position for proximal forearm fractures is ?

Supinated position. ***Supinated position*** - The **supinated position** is generally recommended for proximal forearm fractures because the **biceps brachii** and **supinator muscles**, which are often attached to the proximal fracture segment, cause **supination** when they contract. - Placing the forearm in supination **aligns the distal fracture fragment** with the proximal fragment, promoting better reduction and healing. *Pronated flexion* - **Pronation** would cause the distal fragment to rotate away from the proximal fragment, leading to **malunion** or nonunion. - While some fractures might benefit from a degree of flexion, **pronated flexion** specifically is not the primary position for proximal forearm alignment. *Neutral position* - A **neutral position** might not adequately account for the rotational forces exerted by the biceps and supinator on the proximal fragment, potentially leading to **rotational displacement**. - It does not offer the same alignment benefits as full supination for most proximal forearm fractures. *Position does not matter* - The **cast position is crucial** for forearm fractures, especially proximal ones, as the muscles attached to the forearm bones exert significant rotational forces. - An **incorrect cast position** can lead to rotational deformities, **malunion**, and functional impairment of the forearm.

Q: Garden spade deformity is seen in ?

Smith's fracture. ***Smith's fracture*** - This fracture involves **volar displacement** of the distal radial fragment, causing the characteristic **garden spade deformity** or **reverse Colles' fracture**. - It typically results from a fall onto a **flexed wrist** or a direct blow to the back of the wrist. *Colle’s fracture* - This fracture is characterized by **dorsal displacement** of the distal radial fragment, leading to a **dinner fork deformity**. - It usually occurs from a fall onto an **extended wrist**. *Bennett’s fracture* - This is an **intra-articular fracture** of the base of the **first metacarpal bone**, involving the carpometacarpal joint. - It is often caused by axial loading on a partially flexed thumb. *Barton’s fracture* - This is an **intra-articular fracture** of the distal radius involving either the **dorsal or volar rim**. - It is essentially a **shear fracture** with associated carpal displacement.

Q: What are the common causes of vertebra plana?

All of the options. ***All of the options*** - **Vertebra plana** refers to the severe flattening of a vertebral body, often caused by a destructive lesion, and all listed options are known causes. [5] - While **eosinophilic granuloma** is a classic cause, **metastatic disease** and **tuberculosis** can also lead to significant vertebral collapse. [3], [5] *Eosinophilic granuloma* - This is a benign condition, a form of **Langerhans cell histiocytosis**, which commonly affects children and can cause vertebra plana. [1] - It results from proliferative lesions of **Langerhans cells** that infiltrate the bone, leading to its destruction and collapse. [1] *Metastatic disease* - **Malignant tumors** often spread to the spine, causing osteolytic lesions that weaken the vertebral body. [4], [5] - The destruction caused by metastatic deposits can lead to **vertebral collapse** and associated pain. [5] *Tuberculosis* - **Tuberculosis of the spine (Pott's disease)** is an infectious inflammatory condition that can severely damage vertebral bodies. [2], [3] - The granulomatous inflammation and caseous necrosis can erode the bone, leading to **vertebral collapse** and kyphosis. [2] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 630. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1197-1198. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 669-670. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725. [5] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672.

Question 1

Hot potato voice is characteristic of ?

Accepted Answer

Supraglottic carcinoma

Answer

Nasopharyngeal carcinoma

Answer

Glottic carcinoma

Answer

Subglottic carcinoma

Question 2

What is not true about the use of intranasal steroids in nasal polyposis?

Accepted Answer

Effective in all types of nasal polyps

Answer

May cause nasal irritation

Answer

Reduce recurrence

Answer

Most effective in eosinophilically predominant polyps

Question 3

A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?

Accepted Answer

Early Revascularization with PCI

Answer

Continue conservative management and monitoring of cardiac enzymes and ECG

Answer

Continue conservative management and plan for outpatient follow-up

Answer

Immediate Revascularization with Coronary Angiography

Question 4

What is the most common cause of lobar consolidation?

Accepted Answer

Streptococcus

Answer

Mycoplasma

Answer

Chlamydia

Answer

Legionella

Question 5

Diagnose the underlying medical disorder based on the ECG changes.

Accepted Answer

ECG changes due to hypocalcemia

Answer

ECG changes due to hypokalemia

Answer

ECG changes due to hypercalcemia

Answer

ECG changes due to hyperkalemia

Question 6

Cicatrising trachoma is associated with which stage of the disease?

Accepted Answer

Stage-3

Answer

Stage-1

Answer

Stage-2

Answer

Stage-4

Question 7

Arcuate field defect akin to glaucoma is seen in?

Accepted Answer

Optic nerve lesion

Answer

Pituitary adenoma

Answer

Posterior cerebral artery infarct

Answer

None of the options

Question 8

Most commonly recommended cast position for proximal forearm fractures is ?

Accepted Answer

Supinated position

Answer

Pronated flexion

Answer

Neutral position

Answer

Position does not matter

Question 9

Garden spade deformity is seen in ?

Accepted Answer

Smith's fracture

Answer

Colle’s fracture

Answer

Bennett’s fracture

Answer

Barton’s fracture

Question 10

What are the common causes of vertebra plana?

Accepted Answer

All of the options

Answer

Eosinophilic granuloma

Answer

Metastatic disease

Answer

Tuberculosis

NEET-PG 2013

ENT

Internal Medicine

Ophthalmology

Orthopaedics

Pathology