NEET-PG 2013 Practice Questions

Q: During abdominal surgery under local anesthesia, the patient suddenly felt pain due to

Parietal peritoneum. ***Parietal peritoneum*** - The **parietal peritoneum** is richly innervated by somatic nerves (**spinal nerves**), making it highly sensitive to pain, pressure, and temperature. - When stimulated during surgery, even under local anesthesia which might not completely block deeper somatic nerves or if the local block is inadequate, it can cause the patient to suddenly feel **sharp, localized pain**. *Liver* - The liver itself has very few pain receptors in its parenchyma; pain from the liver typically arises from stretching of its fibrous capsule (**Glisson's capsule**). - This pain is usually dull and poorly localized, not the sudden, sharp pain typically experienced during surgical manipulation. *Intestines* - The intestines are primarily innervated by the **autonomic nervous system** and are sensitive to distension and ischemia, causing visceral pain, which is typically dull, crampy, and poorly localized. - They are generally not sensitive to cutting or burning, which are common surgical manipulations. *Visceral peritoneum* - The **visceral peritoneum** covers abdominal organs and is innervated by the autonomic nervous system, similar to the organs it covers. - Like the intestines, it is sensitive to stretch and ischemia, producing diffuse, poorly localized visceral pain rather than sharp, localized pain from surgical incision or manipulation.

Q: What is a specific indication for the use of a Bone-Anchored Hearing Aid (BAHA)?

Congenital canal atresia. ***Congenital canal atresia*** - **Congenital canal atresia** represents a classic, specific indication for BAHA because the ear canal is congenitally absent or severely stenosed, making conventional hearing aids impossible to fit or ineffective. - BAHA bypasses the absent ear canal entirely by transmitting sound vibrations directly to the **cochlea through bone conduction**, providing an ideal solution for this anatomical abnormality. *Bilateral conductive hearing loss* - While BAHA can be used for conductive hearing loss, **conventional hearing aids** are typically the first-line treatment when ear canals are intact and functional. - Bilateral cases often benefit from traditional amplification devices or **surgical correction** of the underlying conductive pathology before considering BAHA. *Unilateral sensorineural hearing loss* - BAHA is commonly used for **single-sided deafness (SSD)** to route sound from the deaf ear to the hearing ear via bone conduction using the **CROS principle**. - However, this indication is less specific than congenital canal atresia, as other treatment options like **conventional CROS hearing aids** may also be considered. *Conductive hearing loss due to other causes* - This option is too **broad and non-specific** as it encompasses many different etiologies of conductive hearing loss. - Many other causes of conductive hearing loss have **alternative treatments** such as surgical repair, conventional hearing aids, or medical management, making BAHA a secondary consideration.

Q: Early tonsillectomy is not done in?

Thyroid storm. ***Thyroid storm*** - **Thyroid storm** is a life-threatening medical emergency caused by exaggerated hyperthyroidism, requiring immediate medical stabilization to control hormone levels and systemic effects. - Early tonsillectomy is **contraindicated** in this scenario because it would add significant surgical stress and anesthetic risks to an already critically unstable patient. *Peritonsillar abscess* - A **quinsy tonsillectomy** (abscess tonsillectomy) is often performed acutely, especially if drainage is difficult or if it's the first episode, to resolve the abscess and remove the infected tissue. - This procedure can be done in the acute phase of a peritonsillar abscess to relieve symptoms and reduce the risk of recurrence. *Rheumatic fever* - Patients with recurrent **acute tonsillitis** who are at risk of developing **rheumatic fever** are strong candidates for tonsillectomy to prevent further streptococcal infections and subsequent autoimmune complications. - Tonsillectomy is considered a prophylactic intervention in cases of recurrent strep throat leading to rheumatic fever. *Suspected malignancy* - If tonsillar asymmetry or other signs raise suspicion of **tonsillar malignancy**, prompt tonsillectomy is often performed for **diagnostic biopsy** and initial tumor removal. - Early surgical intervention is crucial for diagnosing and staging potential tonsil cancer, which can guide subsequent treatment.

Q: Which of the following is a characteristic finding in distal RTA?

Hypercalciuria. ***Hypercalciuria*** - **Hypercalciuria** is a characteristic finding in distal RTA (Type 1), leading to increased calcium in the urine. - This occurs due to reduced **distal tubular reabsorption of calcium** and increased bone resorption from chronic acidosis. *Urine pH 5.5** [1]. - A urine pH < 5.5 would suggest a normal kidney response to systemic acidosis, ruling out distal RTA. *Hypokalemia* - While hypokalemia can occur in distal RTA, it is not always present and is not the most definitive characteristic finding. - **Hypokalemia** is more characteristic of Type 1 RTA due to increased potassium excretion in an attempt to excrete H+ ions. *Nephrolithiasis* - **Nephrolithiasis** (kidney stones) is a common complication of distal RTA due to hypercalciuria and alkaline urine [2]. - However, hypercalciuria is the *reason* for the increased risk of nephrolithiasis, making it a more fundamental characteristic finding.

Q: Reis-Buckler dystrophy affects which layer of the cornea?

Bowman's membrane. ***Bowman's membrane*** - **Reis-Buckler dystrophy** is a type of corneal dystrophy specifically characterized by the progressive destruction and irregular regeneration of **Bowman's membrane** and the superficial stroma. - This leads to the formation of an abnormal fibrous layer that causes recurrent corneal erosions and significant visual impairment due to corneal opacification. *Epithelium* - While patients often experience recurrent **corneal erosions** involving the epithelium, the primary pathology in Reis-Buckler dystrophy affects the underlying Bowman's membrane. - The epithelial damage is secondary to the irregular surface created by the diseased Bowman's layer. *Stroma* - The **stroma** can be secondarily affected with superficial scarring and opacification in Reis-Buckler dystrophy, but the initial and primary site of pathology is Bowman's membrane. - Other dystrophies, such as macular or granular dystrophies, primarily involve the corneal stroma. *Endothelium* - The **endothelium** is not directly affected in Reis-Buckler dystrophy. - Endothelial dystrophies, such as Fuchs' endothelial dystrophy, involve the innermost layer of the cornea and lead to corneal edema.

Q: Keratitis in contact lens wearers is caused by all except?

Pneumococcus. ***Pneumococcus*** - While *Streptococcus pneumoniae* (Pneumococcus) can cause bacterial keratitis, it is **classically associated with corneal ulcers following trauma** rather than contact lens wear. - In contact lens-related keratitis, Pneumococcus is **significantly less common** compared to *Pseudomonas*, which dominates as the primary bacterial pathogen in this setting. - Pneumococcal keratitis typically presents with a **well-demarcated, dense purulent ulcer with hypopyon**, often following corneal injury. *Pseudomonas* - **_Pseudomonas aeruginosa_** is **the most common cause of bacterial keratitis in contact lens wearers**, accounting for the majority of severe cases. - It thrives in moist environments such as contaminated contact lens cases and solutions, producing **exotoxins and proteases that cause rapid corneal destruction and tissue melt**. - Presents with a **rapidly progressive, dense stromal infiltrate** with a characteristic **ground-glass appearance** and potential for perforation. *Aspergillus* - **_Aspergillus_ species** are an important cause of **fungal keratitis**, particularly associated with contact lens wear, poor lens hygiene, and contaminated lens solutions. - Fungal keratitis presents with **feathery-edged infiltrates, satellite lesions**, and ring-shaped infiltrates, often requiring antifungal therapy. - More common in tropical climates and agricultural settings. *Chlamydia* - **_Chlamydia trachomatis_** is primarily a cause of **trachoma** (chronic follicular conjunctivitis leading to scarring) and **adult inclusion conjunctivitis**. - While it can cause **superficial punctate keratitis and pannus formation** in trachoma, it is **NOT a typical cause of acute suppurative keratitis in contact lens wearers**. - The acute bacterial and fungal keratitis seen in contact lens wearers is a different clinical entity from chlamydial conjunctivitis/keratopathy.

Q: Pilon fracture is

Distal tibia Intraarticular fracture. ***Distal tibia Intraarticular fracture*** - A **pilon fracture** specifically refers to an **intra-articular fracture of the distal tibia**, involving the weight-bearing surface of the **ankle joint**. - These fractures typically result from high-energy axial loading mechanisms, driving the talus into the plafond and causing extensive articular damage. *Bimalleolar fracture* - A **bimalleolar fracture** involves fractures of both the **medial malleolus** (distal tibia) and the **lateral malleolus** (distal fibula). - While it involves the ankle, it does not necessarily involve the **tibial plafond** articular surface in the same destructive manner as a pilon fracture. *Trimalleolar fracture* - A **trimalleolar fracture** includes fractures of the medial, lateral, and **posterior malleolus** (a portion of the distal tibia). - Like bimalleolar fractures, it primarily describes the involvement of the malleoli rather than the intra-articular surface load-bearing portion of the distal tibia. *Proximal tibia fracture* - This term refers to a fracture occurring in the **upper part of the tibia**, near the knee joint. - It does not involve the **distal end of the tibia** or the ankle joint, which is characteristic of a pilon fracture.

Q: What is a Hangman's fracture?

Fracture dislocation of C2. ***Fracture dislocation of C2*** - A Hangman's fracture classically refers to a **bilateral fracture of the pars interarticularis of the axis (C2)**, often with an associated anterior subluxation of C2 on C3. - This injury is typically caused by **hyperextension-distraction forces**, such as those experienced in judicial hangings or motor vehicle accidents. *Subluxation of C5 over C6* - While cervical subluxations are serious, a **C5-C6 subluxation** does not specifically describe a Hangman's fracture. - This type of injury involves different vertebral levels and typically results from different mechanisms. *Fracture dislocation of ankle joint* - This option refers to an injury in the **lower limb**, completely unrelated to the cervical spine. - A Hangman's fracture is a specific type of **cervical vertebral fracture**. *Fracture of odontoid* - A fracture of the odontoid process involves the **dens (odontoid process)** of C2. - This is a distinct type of C2 fracture from a Hangman's fracture, which involves the **pars interarticularis**.

Q: In which condition is the presence of an extra pair of ribs sometimes observed?

Turner syndrome. ***Turner syndrome*** - **Turner syndrome** (45,X) is often associated with skeletal abnormalities, including an extra pair of ribs (cervical ribs) in some cases. - Other common skeletal features include **short stature**, a **shield chest**, and **cubitus valgus**. *Down syndrome* - **Down syndrome** (trisomy 21) is characterized by specific facial features, intellectual disability, and congenital heart defects. - While it can manifest with various skeletal anomalies, an extra pair of ribs is not a characteristic feature. *Klinefelter syndrome* - **Klinefelter syndrome** (47,XXY) is characterized by hypogonadism, tall stature, gynecomastia, and learning difficulties. - Skeletal features may include long limbs and decreased bone density, but cervical ribs are not typically associated with this condition. *Holt-Oram syndrome* - **Holt-Oram syndrome** is a genetic disorder affecting heart and limb development, specifically the upper limbs (thumb abnormalities, phocomelia). - It does not typically involve the presence of an extra pair of ribs. *Fibrous dysplasia* - **Fibrous dysplasia** is a bone disorder where normal bone is replaced by fibrous tissue, leading to weakened bone and fractures. - It is a localized bone condition and does not involve the presence of supernumerary ribs.

Q: Which one of the following is used as a preservative for packing catgut suture?

Isopropyl alcohol. ***Isopropyl alcohol*** - **Isopropyl alcohol** is commonly used as a preservative for **catgut sutures** due to its antiseptic and denaturing properties that prevent microbial growth and maintain the integrity of the biologic material. - It helps to keep the suture sterile and prevents degradation by enzymes or bacteria during storage. *Colloidal iodine* - **Colloidal iodine** is an antiseptic, but it is not typically used as a preservative for **catgut sutures**; it is more often used for skin preparation or wound disinfection. - Its reactivity and potential to stain or alter **suture material** make it less suitable for long-term preservation within the packaging. *Glutaraldehyde* - **Glutaraldehyde** is a potent disinfectant and sterilant, but it is generally too harsh for preserving **catgut sutures**; it can cause significant cross-linking and denaturation of proteins. - It is more commonly used for sterilizing heat-sensitive medical instruments like **endoscopes**, rather than for preserving **suture materials**. *Hydrogen peroxide* - **Hydrogen peroxide** is an oxidizing agent used as an antiseptic to clean wounds or as a sterilant, but it is not suitable for preserving **catgut sutures**. - Its oxidative action could degrade the **collagenous material** of the suture, compromising its strength and absorption properties.

Question 1

During abdominal surgery under local anesthesia, the patient suddenly felt pain due to

Accepted Answer

Parietal peritoneum

Answer

Liver

Answer

Intestines

Answer

Visceral peritoneum

Question 2

What is a specific indication for the use of a Bone-Anchored Hearing Aid (BAHA)?

Accepted Answer

Congenital canal atresia

Answer

Bilateral conductive hearing loss

Answer

Unilateral sensorineural hearing loss

Answer

Conductive hearing loss due to other causes

Question 3

Early tonsillectomy is not done in?

Accepted Answer

Thyroid storm

Answer

Peritonsillar abscess

Answer

Rheumatic fever

Answer

Suspected malignancy

Question 4

Which of the following is a characteristic finding in distal RTA?

Accepted Answer

Hypercalciuria

Answer

Urine pH < 5.5

Answer

Hypokalemia

Answer

Nephrolithiasis

Question 5

Reis-Buckler dystrophy affects which layer of the cornea?

Accepted Answer

Bowman's membrane

Answer

Stroma

Answer

Endothelium

Answer

Epithelium

Question 6

Keratitis in contact lens wearers is caused by all except?

Accepted Answer

Pneumococcus

Answer

Chlamydia

Answer

Aspergillus

Answer

Pseudomonas

Question 7

Pilon fracture is

Accepted Answer

Distal tibia Intraarticular fracture

Answer

Bimalleolar fracture

Answer

Trimalleolar fracture

Answer

Proximal tibia fracture

Question 8

What is a Hangman's fracture?

Accepted Answer

Fracture dislocation of C2

Answer

Fracture dislocation of ankle joint

Answer

Fracture of odontoid

Answer

Subluxation of C5 over C6

Question 9

In which condition is the presence of an extra pair of ribs sometimes observed?

Accepted Answer

Turner syndrome

Answer

Down syndrome

Answer

Holt-Oram syndrome

Answer

Fibrous dysplasia

Answer

Klinefelter syndrome

Question 10

Which one of the following is used as a preservative for packing catgut suture?

Accepted Answer

Isopropyl alcohol

Answer

Colloidal iodine

Answer

Glutaraldehyde

Answer

Hydrogen peroxide

NEET-PG 2013

Anatomy

ENT

Internal Medicine

Ophthalmology

Orthopaedics

Psychiatry

Surgery