NEET-PG 2013 Practice Questions

Q: Rosen's incision is used for which surgical procedure?

Stapedectomy. ***Stapedectomy*** - **Rosen's incision** is a **curved incision in the posterior ear canal** specifically used for **stapedectomy** surgery. - This incision provides excellent exposure of the **middle ear** and particularly the **stapes footplate** for otosclerosis surgery. - The incision extends from approximately **6 o'clock to 12 o'clock** position in the posterior canal, allowing the tympanomeatal flap to be elevated. *Tympanoplasty* - **Tympanoplasty** (repair of perforated tympanic membrane) can use various incisions including **permeatal**, **endaural**, or **postauricular** approaches. - While transmeatal approaches are used, they are not specifically termed "Rosen's incision," which is reserved for stapes surgery. *Septoplasty* - **Septoplasty** is a nasal procedure for correcting a deviated septum using incisions like **hemitransfixion** or **Killian's incision**. - This procedure involves the **nasal septum**, not the ear canal. *Tonsillectomy* - **Tonsillectomy** is performed entirely through an **oral approach** for removal of palatine tonsils. - No external or ear canal incisions are involved.

Q: Electrode of cochlear implant is placed in:

Scala tympani. ***Scala tympani*** - The electrode array of a **cochlear implant** is carefully inserted into the **scala tympani** of the cochlea. - This placement allows the electrodes to directly stimulate the **spiral ganglion neurons**, bypassing damaged hair cells and transmitting electrical signals to the auditory nerve. *Horizontal semicircular canal* - The **horizontal semicircular canal** is part of the **vestibular system**, responsible for sensing angular head movements, not hearing. - Placing an electrode here would cause **vestibular dysfunction** and would not restore hearing. *Scala media* - The **scala media** (cochlear duct) contains the **organ of Corti** and **endolymph**, which has a high potassium concentration. - Inserting an electrode here would damage the delicate structures essential for natural sound transduction and could lead to electric potential imbalances. *Scala vestibuli* - The **scala vestibuli** is filled with **perilymph** and receives sound vibrations from the stapes. - While it's adjacent to the scala tympani, the **scala tympani** offers a safer and more direct path for optimal electrode insertion with less trauma to the sensory structures.

Q: Decreased CVP is seen in

Bacterial sepsis. ***Bacterial sepsis*** - In **sepsis**, widespread **vasodilation** and increased capillary permeability lead to significant fluid redistribution out of the intravascular space [3]. - This results in a decrease in **venous return** and thus a lower **central venous pressure (CVP)** due to relative hypovolemia [2]. *Pneumothorax* - A **pneumothorax** causes increased intrathoracic pressure, compressing the great veins and heart. - This leads to **reduced venous return** and typically an *increase* in CVP, or at least a minimal change, due to obstructed outflow from the right atrium, not a decrease [2]. *PEEP* - **Positive end-expiratory pressure (PEEP)** increases intrathoracic pressure, which impedes venous return to the right atrium [2]. - This elevated pressure can artificially *increase* the measured CVP reading, and it does not typically cause a decrease in intrinsic CVP [2]. *Heart failure* - In **heart failure**, particularly right-sided heart failure or biventricular failure, the heart's pumping efficiency is reduced [1]. - This leads to **venous congestion** and an *increase* in CVP due to fluid overload and the inability of the right ventricle to effectively pump blood forward [2].

Q: Pea soup diarrhea is seen in -

Typhoid. ***Typhoid*** - **Pea soup diarrhea** is a classic symptom of **typhoid fever**, caused by *Salmonella Typhi* [1]. - This characteristic stool is a greenish-yellow watery diarrhea due to inflammation and ulceration of the Peyer's patches in the small intestine [1]. *Cholera* - Characterized by **rice-water stools**, which are profuse, watery, and often contain flecks of mucus, resembling water in which rice has been rinsed [2]. - This type of diarrhea is due to the potent **cholera toxin** causing massive fluid and electrolyte secretion [2]. *Yersinosis* - Causes diarrhea that can range from watery to bloody, often associated with severe **abdominal pain** mimicking appendicitis. - While it can cause enterocolitis, the stool consistency is not typically described as "pea soup" like in typhoid. *Hepatitis* - Hepatitis primarily affects the **liver** and typically does **not cause diarrhea** as a prominent symptom. - Common symptoms include jaundice, dark urine, and pale stools due to impaired bilirubin metabolism.

Q: What is the most common infection in contact lens users?

Pseudomonas. ***Pseudomonas*** - **Pseudomonas aeruginosa** is the leading cause of **bacterial keratitis** in contact lens wearers, accounting for 60-70% of culture-positive cases - This bacterium can **adhere to lenses**, form **biofilms**, and thrive in moist lens storage cases - Can cause rapid and severe corneal damage with **corneal ulceration**, potentially leading to **vision loss** *Staphylococcus* - **Staphylococcus aureus** and **Staphylococcus epidermidis** are common commensals of the skin and can cause eye infections, including keratitis and blepharitis - However, in the context of contact lens-related keratitis, **Pseudomonas aeruginosa** remains the primary pathogen for severe corneal infections *Streptococcus* - While various **Streptococcus species** (especially S. pneumoniae) can cause bacterial keratitis, they are less commonly associated with contact lens-related keratitis compared to Pseudomonas - **Streptococcal keratitis** typically occurs in non-contact lens wearers or after trauma *Neisseria* - **Neisseria gonorrhoeae** can cause hyperacute bacterial conjunctivitis with severe purulent discharge, but is not the most common cause of contact lens-related keratitis - **Neisseria meningitidis** can rarely cause conjunctivitis, but these infections usually indicate specific exposure or systemic disease

Q: Interstitial keratitis is associated with all of the following except:

Acanthamoeba. ***Acanthamoeba*** - **Acanthamoeba keratitis** is a **suppurative keratitis** characterized by a painful, ring-shaped infiltrate with epithelial ulceration, typically associated with contact lens use and contaminated water exposure. - It causes **ulcerative stromal inflammation**, not the **non-ulcerative deep stromal inflammation** that characterizes classic interstitial keratitis. - **This is NOT a cause of interstitial keratitis.** *Syphilis* - **Congenital syphilis** is the **CLASSIC cause** of bilateral **interstitial keratitis**, often presenting in late childhood with "salmon patch" appearance, photophobia, lacrimation, and eventual ghost vessels. - The inflammation is **non-ulcerative and chronic**, affecting the **deep corneal stroma** with preservation of epithelium. - This is the most important association with interstitial keratitis to remember. *Chlamydia Trachomatis* - **Chlamydia trachomatis** causes **trachoma**, a chronic keratoconjunctivitis leading to **superficial keratitis with pannus formation** (superficial vascularization from the limbus). - The corneal involvement in trachoma is **superficial**, not the deep stromal inflammation seen in classic interstitial keratitis. - While listed in some references, **Chlamydia is NOT a standard cause of interstitial keratitis** in major ophthalmology textbooks. - **Note:** This option is potentially debatable, but Acanthamoeba is the more definitively incorrect answer. *Herpes Zoster Virus (HZV)* - **Herpes zoster ophthalmicus** can lead to **interstitial keratitis** and **disciform keratitis** (immune-mediated stromal inflammation with disc-shaped corneal edema). - Similarly, **HSV (Herpes Simplex Virus)** causes stromal keratitis, a form of interstitial keratitis. - The corneal involvement includes **deep stromal inflammation, scarring**, and potential neurotrophic changes leading to vision impairment.

Q: Which of the following conditions is associated with male pseudohermaphroditism?

5-alpha reductase deficiency. ***5-alpha reductase deficiency*** - This deficiency prevents the conversion of **testosterone into dihydrotestosterone (DHT)**, which is essential for external male genitalia development. - Individuals with XY chromosomes are born with **ambiguous genitalia** that may appear female-like, leading to male pseudohermaphroditism. *21-hydroxylase deficiency* - This is the most common cause of **congenital adrenal hyperplasia (CAH)**, leading to overproduction of androgens. [1] - In XX individuals, it causes **virilization**, resulting in female pseudohermaphroditism, not male. [1] *17-hydroxylase deficiency* - This leads to impaired synthesis of **cortisol and sex steroids**, thus affecting adrenal and gonadal functions. [1] - XY individuals with this deficiency typically present with **female external genitalia** due to a lack of androgens, but it's a different mechanism than 5-alpha reductase deficiency. [1] *Androgen insensitivity syndrome* - In this condition, individuals with XY chromosomes have **non-functional androgen receptors**, making their bodies unable to respond to testosterone. [1] - They develop **female external genitalia** despite having testes and usually present as phenotypic females. [1]

Q: A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?

Fungal infection. ***Fungal infection (Candida diaper dermatitis)*** - **Diarrhea with perianal diaper rash** is the classic presentation of **Candida (fungal) diaper dermatitis**, the most common cause of diaper rash in infants with diarrhea. - **Diarrhea increases skin moisture and alters pH**, creating optimal conditions for **Candida albicans overgrowth**. - **Perianal involvement with bright erythema** is characteristic of Candida, often with **satellite lesions** and involvement of skin folds. - This is a **clinical diagnosis** based on distribution pattern and association with diarrhea; consanguinity is not directly relevant to this common condition. *Lactose intolerance* - **Congenital lactase deficiency** is extremely rare (< 50 cases worldwide) and unlikely to be the primary diagnosis. - While **secondary lactose intolerance** can occur with gastroenteritis causing diarrhea, it doesn't explain the **specific perianal rash pattern** described. - The perianal redness in lactose malabsorption would be **irritant contact dermatitis** from acidic stools, which would secondarily get infected with **Candida** - making fungal infection the more complete diagnosis. *Shigella infection* - Typically presents with **bloody diarrhea (dysentery)**, high fever, abdominal cramps, and tenesmus. - Would not specifically cause the **perianal diaper rash pattern** characteristic of Candida. - Consanguinity doesn't predispose to this bacterial infection. *Salmonella infection* - Usually presents with **fever, vomiting, and systemic symptoms** along with diarrhea. - May cause bloody or non-bloody diarrhea but doesn't explain the **characteristic perianal redness pattern**. - Not associated with consanguinity as it's an acquired infectious disease.

Q: Which of the following is markedly decreased in restrictive lung disease?

FVC. ***FVC*** - In **restrictive lung disease**, there is a reduction in lung volume due to various causes, leading to a markedly decreased **Forced Vital Capacity (FVC)**. - **FVC** directly measures the total amount of air a person can exhale after a maximal inhalation, which is inherently limited in restrictive conditions. - This is the **hallmark finding** in restrictive lung disease and the most clinically significant decrease. *FEV1* - While **FEV1** (Forced Expiratory Volume in 1 second) is also decreased in restrictive lung disease, its decrease is proportional to the FVC decrease. - A decrease in FEV1 alone is less specific, as it could also indicate obstructive lung disease. - The key is that both FEV1 and FVC decrease together, maintaining a normal or increased ratio. *FEV1/FVC* - The **FEV1/FVC ratio** is typically **normal or even increased** in restrictive lung disease, as both FEV1 and FVC decrease proportionally or FEV1 decreases slightly less. - A decreased FEV1/FVC ratio is characteristic of **obstructive lung disease**, not restrictive. *RV* - **Residual Volume (RV)** is also **decreased** in restrictive lung disease, along with all other lung volumes (TLC, VC, FRC). - However, RV is not measured by standard spirometry and requires body plethysmography or gas dilution techniques. - While RV does decrease, **FVC** is the more clinically significant and readily measurable parameter that is "markedly decreased" and defines restrictive disease on routine pulmonary function testing.

Q: Among the following, intraoperative sentinel lymph node detection in axilla can be done using

Isosulfan blue dye. ***Correct Option: Isosulfan blue dye*** - **Isosulfan blue dye** is a vital dye used for **intraoperative visual identification** of sentinel lymph nodes in the axilla during breast cancer surgery - The dye is injected near the tumor site and **preferentially concentrates in lymphatic channels**, allowing the surgeon to visually trace the lymphatic drainage to the **first lymph node(s)** (sentinel nodes) receiving lymph flow - The sentinel nodes appear **blue-stained** and can be identified and excised for biopsy to determine lymph node status - **Alternative methods** include radioactive tracers like **Technetium-99m** or a combination of both (dual mapping technique) *Incorrect Option: Mammography* - Mammography is an **X-ray imaging technique** used for breast cancer screening and diagnosis to detect tumors and calcifications - It is a **pre-operative diagnostic tool**, not used for intraoperative sentinel lymph node detection - Cannot visualize or track lymphatic flow during surgery *Incorrect Option: MRI* - MRI (Magnetic Resonance Imaging) provides detailed anatomical assessment and staging of breast cancer pre-operatively - It is a **static imaging modality** that cannot be used for real-time intraoperative sentinel lymph node detection - Does not visualize lymphatic drainage or dye uptake during surgery *Incorrect Option: CT* - CT scans (Computed Tomography) provide cross-sectional images useful for assessing tumor size and metastatic spread - Not employed for **intraoperative sentinel lymph node detection** - Cannot track real-time lymphatic flow with dyes during surgery

Question 1

Rosen's incision is used for which surgical procedure?

Accepted Answer

Stapedectomy

Answer

Septoplasty

Answer

Tonsillectomy

Answer

Tympanoplasty

Question 2

Electrode of cochlear implant is placed in:

Accepted Answer

Scala tympani

Answer

Horizontal semicircular canal

Answer

Scala media

Answer

Scala vestibuli

Question 3

Decreased CVP is seen in

Accepted Answer

Bacterial sepsis

Answer

PEEP

Answer

Heart failure

Answer

Pneumothorax

Question 4

Pea soup diarrhea is seen in -

Accepted Answer

Typhoid

Answer

Cholera

Answer

Yersinosis

Answer

Hepatitis

Question 5

What is the most common infection in contact lens users?

Accepted Answer

Pseudomonas

Answer

Streptococcus

Answer

Staphylococcus

Answer

Neisseria

Question 6

Interstitial keratitis is associated with all of the following except:

Accepted Answer

Acanthamoeba

Answer

Syphilis

Answer

Chlamydia Trachomatis

Answer

Herpes Zoster Virus (HZV)

Question 7

Which of the following conditions is associated with male pseudohermaphroditism?

Accepted Answer

5-alpha reductase deficiency

Answer

21-hydroxylase deficiency

Answer

Androgen insensitivity syndrome

Answer

17-hydroxylase deficiency

Question 8

A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?

Accepted Answer

Fungal infection

Answer

Shigella infection

Answer

Salmonella infection

Answer

Lactose intolerance

Question 9

Which of the following is markedly decreased in restrictive lung disease?

Accepted Answer

FVC

Answer

RV

Answer

FEV1/FVC

Answer

FEV1

Question 10

Among the following, intraoperative sentinel lymph node detection in axilla can be done using

Accepted Answer

Isosulfan blue dye

Answer

Mammography

Answer

MRI

Answer

CT

NEET-PG 2013

ENT

Internal Medicine

Ophthalmology

Pathology

Pediatrics

Physiology

Surgery