NEET-PG 2013 Practice Questions

Q: What are the X-ray findings associated with chronic otitis media?

Sclerosis with cavity in mastoid. ***Sclerosis with cavity in mastoid*** - Chronic otitis media leads to **long-standing inflammation** and **destruction** of the mastoid air cells, resulting in dense, **sclerotic bone** with cavity formation due to bone erosion. - This is the **characteristic X-ray finding** in chronic otitis media, indicating osseous remodeling and bone destruction from persistent infection. - The sclerosis represents reactive bone formation, while cavities form from **coalescence** of destroyed air cells. *Honeycombing of mastoid* - Honeycombing describes a **normal, well-pneumatized mastoid** with numerous small, distinct air cells visible on X-ray. - This appearance indicates a healthy mastoid bone with good aeration and is **inconsistent** with chronic inflammation. - Chronic otitis media causes bone remodeling and sclerosis, **not** preserved pneumatization. *Clear-cut distinct bony partition between cells* - This describes **normal mastoid anatomy** where air cells are well-defined and separated by thin, intact bony septa. - In chronic otitis media, these septa are typically **eroded or thickened** by inflammation, leading to loss of distinctness. - The inflammatory process causes destruction and sclerosis, **not** preservation of normal architecture. *Increased pneumatization of mastoid cells* - Increased pneumatization indicates **excessive air cell development**, which is opposite to the changes seen in chronic infection. - Chronic otitis media causes **destruction and sclerosis** of air cells, not increased pneumatization. - This would be seen in normal developmental variants, not chronic inflammatory disease.

Q: In otosclerosis, the tympanogram is:

Low compliance. ***Low compliance*** - In **otosclerosis**, the **stapes footplate** becomes fixed in the **oval window**, hindering sound transmission. - This fixation leads to reduced movement of the **tympanic membrane** and ossicular chain, resulting in a **low-compliance tympanogram** (Type As). *High compliance* - **High compliance** (Type Ad tympanogram) indicates a very mobile or **flaccid tympanic membrane**, often seen in conditions like **ossicular discontinuity**. - This is opposite to the stiffening effect seen in otosclerosis. *Normal compliance* - A **normal tympanogram** (Type A) signifies healthy middle ear function with appropriate pressure and mobility. - This would not be observed in otosclerosis, where there is a clear pathology affecting the **ossicular chain** and sound conduction. *None of the options* - This is incorrect because **otosclerosis** presents with a characteristic **low-compliance tympanogram**. - The disease specifically impairs the **mobility of the middle ear system**, which directly impacts tympanometric findings.

Q: What condition is characterized by a bluish appearance of the tympanic membrane?

Otitis media with effusion. ***Otitis media with effusion (with hemotympanum)*** - A bluish appearance of the tympanic membrane is characteristically seen when there is **blood in the middle ear space (hemotympanum)**, which can occur in **otitis media with effusion containing hemorrhagic fluid**. - The blue discoloration results from **blood or hemorrhagic effusion** behind the intact tympanic membrane, which imparts a blue or purple hue when visualized through the translucent drum. - This can occur with **traumatic hemotympanum** (basal skull fracture, temporal bone trauma), **hemorrhagic OME**, or in patients with **bleeding disorders**. - Classic causes of blue tympanic membrane include middle ear hemorrhage associated with effusion. *Chronic suppurative otitis media* - CSOM typically involves persistent **purulent (pus-filled) discharge** and often a **perforation of the tympanic membrane**. - The tympanic membrane in CSOM is usually **inflamed, thickened, or perforated**, with active mucopurulent drainage rather than a bluish tinge. - The blue discoloration specifically indicates **blood in the middle ear**, not purulent infection. *Normal tympanic membrane* - A normal tympanic membrane is **pearly gray, translucent**, and mobile, with a visible cone of light and normal middle ear landmarks. - It does not exhibit bluish discoloration, which specifically indicates **underlying hemorrhage or hemorrhagic fluid** in the middle ear space. *Tympanic membrane perforation* - A perforation is a **visible hole or defect in the eardrum**, often with evidence of drainage. - While perforations can occur with various middle ear pathologies, a **blue/purple discoloration of an intact drum** specifically indicates **hemotympanum** (blood behind the membrane), not a perforation itself.

Q: Graham Steell murmur is associated with which of the following conditions?

Pulmonary Regurgitation (PR). ***Pulmonary Regurgitation (PR)*** - The **Graham Steell murmur** is a high-pitched, decrescendo early diastolic murmur heard best at the left sternal border associated with **pulmonary hypertension**. [1] - It results from dilation of the pulmonary artery due to **elevated pulmonary pressures**, leading to functional pulmonary valve regurgitation. [1] *Tricuspid Regurgitation (TR)* - TR typically presents as a **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It is caused by improper coaptation of the tricuspid valve leaflets, often due to **right ventricular dilation**. *Tricuspid Stenosis (TS)* - TS is characterized by a **diastolic rumble** heard best at the lower left sternal border, often with an opening snap. [2] - It is relatively rare and often associated with **rheumatic heart disease**. *Pulmonary Stenosis (PS)* - PS typically produces a **systolic ejection murmur** heard at the upper left sternal border, often radiating to the back. - It is caused by **obstruction to blood flow** from the right ventricle to the pulmonary artery.

Q: Which of the following conditions is associated with megaloblastic anemia?

Pernicious anemia. a and b - Megaloblastic anemia is commonly associated with **vitamin B12** [1] and **folate deficiencies** [2], which can occur due to various causes. - Conditions leading to malabsorption (such as those related to the gastrointestinal tract) contribute significantly to megaloblastic anemia [1, 2]. *ileal resection* - Ileal resection can indeed lead to **malabsorption** of vitamin B12 [1], particularly if the distal ileum is removed. - However, it is important to note that megaloblastic anemia specifically reflects a broader range of potential deficiencies, thus it is not an exclusive answer. *Crohn's disease* - Crohn's disease can cause **malabsorption** and result in vitamin B12 deficiency but is not a direct cause of megaloblastic anemia on its own. - The anemia may occur due to complications like **ileo-pouch anastomosis** rather than the disease itself. *Intestinal lymphatic ectasia* - This condition leads to **protein-losing enteropathy**, potentially causing deficiencies but not specifically leading to megaloblastic anemia. - The anemia associated with this condition is typically due to **hypoalbuminemia** and not a result of any vitamin deficiency directly.

Q: The physiological marker of the last stage of acute asthma is

Increased carbon dioxide levels (Hypercapnia). ***Increased carbon dioxide levels (Hypercapnia)*** - In severe, acute asthma, **air trapping** and **muscle fatigue** lead to inadequate ventilation and impaired gas exchange [1]. - This results in a buildup of carbon dioxide in the blood, indicating impending **respiratory failure** and a critical stage of the asthma exacerbation [3]. *Hypocapnia* - **Hypocapnia**, or low blood CO2, is common in the **early stages** of an asthma attack due to **tachypnea** (rapid breathing) in an effort to compensate [1]. - As the condition worsens, the ability to ventilate adequately diminishes, leading to CO2 retention [3]. *Hyperoxia* - **Hyperoxia** means abnormally high levels of oxygen in the blood, which is generally not a physiological marker of acute asthma. - Patients with acute asthma typically experience **hypoxemia** (low oxygen levels) due to ventilation-perfusion mismatch [1]. *Alkalosis* - **Respiratory alkalosis** (high pH due to low CO2) can occur in the early stages as patients **hyperventilate**. - However, in the late stages, as CO2 builds up (**hypercapnia**), the patient shifts towards **respiratory acidosis** (low pH), which is a sign of severe compromise [2], [3].

Q: Yoke muscle for the right superior rectus is:

Left Inferior Oblique. ***Left Inferior Oblique*** - Yoke muscles are pairs of synergistic muscles, one in each eye, that act together to produce conjugate eye movements in the same direction of gaze. - The **right superior rectus** and **left inferior oblique** are yoke muscles that work together during **upward and rightward gaze** (dextro-elevation) [1]. - Right SR elevates the **adducted** right eye, while left IO elevates the **abducted** left eye, producing coordinated upward-right movement [1]. - This follows **Hering's Law of Equal Innervation**, where yoke muscles receive equal and simultaneous innervation. *Left Superior rectus* - The left superior rectus is the **contralateral homologous muscle**, not a yoke muscle for the right superior rectus. - Both superior recti work together for **upward gaze in primary position**, but they are versional muscles, not yoke pairs. - Yoke muscles produce conjugate movements in oblique directions, not straight up. *Left Inferior rectus* - The left inferior rectus depresses the left eye and is an antagonist to elevation. - It would pair with the **right superior oblique** for downward-left gaze (levo-depression), not with the right superior rectus. *Left Lateral Rectus* - The left lateral rectus is responsible for **abduction** of the left eye (leftward gaze). - Its yoke muscle is the **right medial rectus** for leftward horizontal gaze (levoversion), not for upward-right gaze.

Q: What is the most common site for carcinoid tumor?

Ileum. ***Ileum*** - The **ileum** is the most common site for carcinoid tumors, accounting for nearly **50%** of cases [1]. - Carcinoid tumors arise from **neuroendocrine cells** in the gastrointestinal tract, with the ileum being particularly common due to its abundant neuroendocrine tissue [1]. *Appendix* - While carcinoid tumors can occur in the **appendix**, they represent a smaller proportion compared to those found in the ileum. - Typical carcinoid tumors in the appendix are often **asymptomatic** and usually detected incidentally. *Lung* - Though lung carcinoids exist, they represent a different classification of carcinoid tumors, primarily occurring in the **bronchial tree** [2]. - They are less common than those in the gastrointestinal tract, particularly the ileum. *Esophagus* - Carcinoid tumors are rare in the **esophagus** and typically have different presentations compared to gastrointestinal carcinoids. - The esophagus is not a common site for carcinoid tumors, which are primarily found in the intestinal tract. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 727.

Q: Indication for sentinel node biopsy is:

Non-palpable axillary lymph node. ***Non-palpable axillary lymph node*** - **Sentinel lymph node biopsy (SLNB)** is indicated when there is no clinical evidence of axillary lymph node involvement, meaning the nodes are **non-palpable**. - Its purpose is to identify micrometastases that would not be detectable by physical examination, staging the cancer more accurately and guiding further treatment. *Palpable axillary lymph node* - A **palpable axillary lymph node** suggests macroscopic nodal involvement, usually requiring a fine needle aspiration (FNA) or core needle biopsy for diagnosis. - If positive, these patients typically proceed directly to **axillary lymph node dissection (ALND)** rather than SLNB. *Mass > 5 cm* - The size of the primary tumor (e.g., > 5 cm) is a factor in staging but does not, in itself, preclude or indicate SLNB. - While larger tumors have a higher risk of nodal involvement, the decision for SLNB still hinges on the clinical status of the axilla (palpable vs. non-palpable nodes). *Metastasis* - If **distant metastasis** is confirmed, the focus shifts to palliative care and systemic treatment, making a regional staging procedure like SLNB less relevant or unnecessary. - SLNB is used for staging early-stage cancer to detect regional spread, not when widespread disease is already established.

Question 1

What are the X-ray findings associated with chronic otitis media?

Accepted Answer

Sclerosis with cavity in mastoid

Answer

Honeycombing of mastoid

Answer

Clear-cut distinct bony partition between cells

Answer

Increased pneumatization of mastoid cells

Question 2

In otosclerosis, the tympanogram is:

Accepted Answer

Low compliance

Answer

High compliance

Answer

Normal compliance

Answer

None of the options

Question 3

What condition is characterized by a bluish appearance of the tympanic membrane?

Accepted Answer

Otitis media with effusion

Answer

Chronic suppurative otitis media

Answer

Normal tympanic membrane

Answer

Tympanic membrane perforation

Question 4

Graham Steell murmur is associated with which of the following conditions?

Accepted Answer

Pulmonary Regurgitation (PR)

Answer

Tricuspid Regurgitation (TR)

Answer

Tricuspid Stenosis (TS)

Answer

Pulmonary Stenosis (PS)

Question 5

Which of the following conditions is associated with megaloblastic anemia?

Accepted Answer

Pernicious anemia

Answer

Iron deficiency anemia

Answer

Intestinal lymphatic ectasia

Answer

Chronic kidney disease

Question 6

The physiological marker of the last stage of acute asthma is

Accepted Answer

Increased carbon dioxide levels (Hypercapnia)

Answer

Hypocapnia

Answer

Hyperoxia

Answer

Alkalosis

Question 7

Yoke muscle for the right superior rectus is:

Accepted Answer

Left Inferior Oblique

Answer

Left Lateral Rectus

Answer

Left Superior rectus

Answer

Left Inferior rectus

Question 8

What is the most common site for carcinoid tumor?

Accepted Answer

Ileum

Answer

Lung

Answer

Esophagus

Answer

Appendix

Question 9

What causes Frey's syndrome?

Accepted Answer

Aberrant regeneration of parasympathetic fibers from the auriculotemporal nerve to sweat glands.

Answer

Facial nerve damage.

Answer

Greater auricular nerve involvement.

Answer

None of the options

Question 10

Indication for sentinel node biopsy is:

Accepted Answer

Non-palpable axillary lymph node

Answer

Palpable axillary lymph node

Answer

Metastasis

Answer

Mass > 5 cm

NEET-PG 2013

ENT

Internal Medicine

Ophthalmology

Pathology

Surgery