NEET-PG 2013 Practice Questions

Q: Which of the following is not an absolute indication for hemodialysis?

GI bleeding. ***GI bleeding*** - While patients on dialysis may experience gastrointestinal bleeding, it is not a direct indication for initiating or continuing **hemodialysis**. - **GI bleeding** in end-stage renal disease (ESRD) patients can be due to various causes and requires specific management of the bleeding itself, not necessarily an alteration in dialysis prescription. *Convulsions* - **Convulsions** in patients with renal failure, especially due to uremia, are a severe manifestation of **uremic encephalopathy**. - This is an absolute indication for **hemodialysis** as it rapidly removes uremic toxins causing central nervous system dysfunction. *Pericarditis* - **Uremic pericarditis**, characterized by inflammation of the pericardium due to accumulation of uremic toxins, is a serious complication of renal failure. - It is an absolute indication for **hemodialysis** to prevent further cardiac complications like cardiac tamponade. *Hyperkalemia of 6.5 mEq/L* - Severe **hyperkalemia** (typically > 6.0-6.5 mEq/L) is a life-threatening electrolyte imbalance that can cause cardiac arrhythmias. - **Hemodialysis** is highly effective in rapidly removing potassium from the body and is an absolute indication, especially if unresponsive to other medical therapies.

Q: Subclavian steal syndrome is

Reversal of blood flow in the ipsilateral vertebral artery. ***Reversal of blood flow in the ipsilateral vertebral artery*** - Subclavian steal syndrome occurs due to a **proximal stenosis** or **occlusion of the subclavian artery**. - This causes blood to be "stolen" from the **ipsilateral vertebral artery**, flowing retrograde to supply the arm and thereby reducing blood flow to the brainstem. *Reversal of blood flow in the contralateral carotid artery* - The carotid arteries supply blood to the brain directly and are typically not directly involved in thesteal phenomenon in this specific syndrome. - Reversal of flow in the carotid artery would indicate a much more severe and different pathology, not characteristic of subclavian steal. *Reversal of blood flow in the contralateral vertebral artery* - The steal phenomenon specifically involves the vertebral artery on the **same side (ipsilateral)** as the subclavian artery obstruction. - The contralateral vertebral artery would typically continue to supply blood to the brain without a reversed flow in this syndrome. *B/L reversal of blood flow in vertebral arteries* - Subclavian steal syndrome is generally a **unilateral phenomenon**, affecting the vertebral artery ipsilateral to the subclavian artery stenosis. - Bilateral reversal would imply bilateral subclavian artery obstruction or other severe cerebrovascular disease, which is not the definition of subclavian steal syndrome itself.

Q: What is the purpose of the Queckenstedt test?

Spinal block. ***Spinal block*** - The Queckenstedt test was historically used to evaluate for a **spinal block**, which is an obstruction to the free flow of **cerebrospinal fluid (CSF)** in the subarachnoid space. - It involves observing the rise in **CSF pressure** in response to compression of the jugular veins; a blunted or absent rise suggests a block. *Glomus tumor* - **Glomus tumors** are usually benign and arise from glomus bodies, often presenting as painful lesions in the nail bed. - Their diagnosis is typically made through **imaging** and **biopsy**, not specific pressure tests. *Otosclerosis* - **Otosclerosis** is a condition causing progressive hearing loss due to abnormal bone growth in the middle ear. - Diagnosis involves **audiometry** and **tympanometry**, and it is unrelated to CSF flow or spinal blocks. *Acoustic neuroma* - An **acoustic neuroma** is a benign tumor of the vestibulocochlear nerve (cranial nerve VIII) that causes hearing loss, tinnitus, and balance issues. - Diagnosis relies on **MRI of the brain**, and the Queckenstedt test has no role in its evaluation.

Q: Commotio retinae affects which part of the retina -

Posterior pole. ***Posterior pole*** - **Commotio retinae**, also known as Berlin's edema, primarily affects the **posterior pole** of the retina, particularly the macula. - This condition results from **blunt trauma** to the globe, causing disruption of the outer retinal photoreceptors and retinal pigment epithelium, leading to retinal whitening in the area of impact. *Peripheral retina* - While blunt trauma can affect the peripheral retina, commotio retinae specifically refers to the **edematous whitening** that occurs more centrally. - Trauma to the periphery is more commonly associated with **retinal tears or detachments**, rather than the diffuse whitening seen in commotio retinae. *Inferior-nasal part* - This is a specific quadrant of the retina, but commotio retinae is not confined to or preferentially found in the **inferior-nasal part**. - The location of commotio retinae depends on the **point of impact** and the transmission of force, but symptoms are most prominent when the macula at the posterior pole is involved. *Superior-nasal part* - Similar to the inferior-nasal part, the **superior-nasal part** is a specific retinal quadrant. - Commotio retinae is a more generalized finding of retinal edema and whitening due to trauma, not consistently localized to this particular region, though it can occur if that area is directly impacted.

Q: What condition is associated with copper deposition in the cornea?

Wilson's disease. ***Wilson's disease*** - Wilson's disease is a genetic disorder of **copper metabolism** leading to excess copper accumulation in various tissues, including the cornea [1]. - This copper deposition in the posterior Descemet's membrane of the cornea forms a distinctive golden-brown or greenish-brown ring known as the **Kayser-Fleischer ring**. *Keratoconus* - This condition is characterized by progressive thinning and steepening of the cornea, causing it to bulge into a **cone-like shape**. - It primarily affects vision due to irregular astigmatism and does not involve copper deposition. *Keratoglobus* - Keratoglobus is a rare corneal ectatic disorder where the entire cornea is thinned and bulges forward, giving it a **globe-like appearance**. - It is congenital and typically runs in families, and it is not associated with copper deposition. *Siderosis* - Siderosis refers to the deposition of **iron** in various tissues, often due to chronic hemorrhage or metallic foreign bodies. - In the eye, it can occur after intraocular iron foreign bodies, leading to retinal degeneration and other ocular complications, but it does not involve copper.

Q: Maximum correction of myopia can be done by?

LASIK. ***LASIK*** - **LASIK (Laser-Assisted In Situ Keratomileusis)** allows for significant correction of high myopia by reshaping the cornea with an excimer laser. - It involves creating a **corneal flap** and then ablating tissue underneath, offering precise and stable vision correction for a wide range of refractive errors. - Among the given corneal refractive procedures, LASIK can correct myopia up to **-10 to -12 D**. *Radial keratotomy* - **Radial keratotomy (RK)** involves making radial incisions in the cornea to flatten it, primarily used for low to moderate myopia (up to -3 to -4 D). - It has a higher risk of **unpredictable outcomes**, induced astigmatism, and glare compared to modern laser procedures. *Photorefractive keratectomy* - **Photorefractive keratectomy (PRK)** involves direct ablation of the corneal surface without creating a flap, which is suitable for moderate myopia (up to -8 to -10 D). - While effective, PRK typically has a **longer recovery period** and more post-operative pain than LASIK. *Orthokeratology* - **Orthokeratology (Ortho-K)** uses specially designed rigid contact lenses worn overnight to temporarily reshape the cornea and correct myopia. - The effect is **temporary**, requiring continuous lens wear to maintain vision correction, and is generally limited to low to moderate myopia (up to -4 to -6 D).

Q: At what age can children typically draw a square?

5 years. ***5 years*** - At 5 years old, children have developed the **fine motor skills** and **cognitive abilities** necessary to copy and draw a square independently. - This is a key developmental milestone reflecting improved **visual-motor coordination** and understanding of geometric shapes with corners and angles. - By this age, children can also draw recognizable human figures with multiple body parts. *3 years* - While 3-year-olds can copy a circle and draw vertical/horizontal lines, they typically lack the **fine motor precision** and spatial understanding to draw a square with four equal sides and right angles. - Their drawings of angular shapes are crude approximations or scribbles rather than recognizable squares. *6 years* - By 6 years of age, children are proficient at drawing squares and other basic shapes, and are beginning to draw more complex figures with **perspective** and greater detail. - This age represents refinement beyond the initial mastery of drawing a square, which typically occurs at 5 years. *7 years* - At 7 years old, children have long mastered drawing basic shapes like squares and are capable of drawing objects with **depth and perspective** using multiple shapes, lines, and colors. - They demonstrate more advanced artistic expression and detailed representations.

Q: Which CT view is best for visualizing paranasal polyps?

Coronal view. ***Coronal*** - The **coronal view** provides the best visualization of the **ostia of the paranasal sinuses**, which are crucial for assessing the extent and obstruction caused by polyps. - This orientation effectively demonstrates whether polyps are **protruding into the nasal cavity** or obstructing the drainage pathways. *Axial view* - The axial view is useful for evaluating **posterior structures** and **bony erosion** but is less optimal for assessing the vertical extent of polyps or ostial obstruction. - It can show the **anteroposterior dimensions** of polyps but does not offer the same clarity for sinus outflow tracts as the coronal view. *Sagittal view* - The sagittal view is good for showing the **craniocaudal extent** of lesions and differentiating between the nasal cavity and sphenoid sinus, but it is not ideal for comprehensive paranasal sinus polyp evaluation. - It can help in localizing some polyps but does not provide a clear overview of **sinus ostia** or lateral extension. *3D view* - A 3D reconstruction can be helpful for a general overview and surgical planning but does not offer the fine detail and specific orientation needed for primary polyp detection and ostial assessment as effectively as direct 2D views. - It is a derived image rather than a primary acquisition plane and might obscure smaller polyps or subtle anatomical relationships.

Q: A chest X-ray shows bilateral lung infiltrates. What is the next best investigation?

CT. ***CT*** - A **CT scan (preferably HRCT)** provides a more detailed view of the lung parenchyma, allowing for better characterization of the infiltrates (e.g., location, pattern, presence of nodules, ground-glass opacities, or consolidation). - This detailed imagery is crucial for narrowing down the differential diagnosis and guiding further diagnostic or therapeutic interventions. - **CT is the best next investigation** for characterizing bilateral lung infiltrates seen on chest X-ray. *Sputum examination* - While important for identifying infectious causes, **sputum examination** is often only productive in certain types of pneumonia or infections and might not directly clarify the morphology or distribution of the infiltrates as a CT scan would. - It might be a subsequent step once the nature of the infiltrate is better understood through imaging. *Bronchoscopy* - **Bronchoscopy** is an invasive procedure generally reserved for cases where less invasive methods have failed to yield a diagnosis or when specific findings from imaging (like a CT scan) suggest the need for direct visualization, lavage, or biopsy. - It's not typically the immediate next step after identifying bilateral infiltrates on a chest X-ray. *Echocardiography* - **Echocardiography** is useful for evaluating cardiac causes of bilateral infiltrates (such as pulmonary edema from heart failure). - However, it does not directly visualize or characterize the lung parenchymal infiltrates themselves, making CT more valuable as the next investigation.

Q: Which of the following is the best combination of clinical features of intestinal obstruction?

Abdominal distension and vomiting. ***Abdominal distension and vomiting*** - This combination represents **two of the cardinal clinical features** of intestinal obstruction from the classic tetrad (pain, vomiting, distension, constipation). - **Abdominal distension** occurs due to accumulation of gas and fluid proximal to the obstruction. - **Vomiting** occurs as the body attempts to expel contents that cannot pass through the blocked intestine. - The **combination** makes this the most specific and complete answer among the given options. *Vomiting* - While vomiting is indeed a prominent clinical feature of intestinal obstruction, it can occur in numerous other conditions (gastroenteritis, metabolic disorders, CNS pathology). - **Isolated vomiting lacks specificity** for diagnosing intestinal obstruction. *Fluid level in X-ray > 4* - This refers to **multiple air-fluid levels** seen on erect abdominal X-ray, which is a **radiologic/diagnostic finding**, not a clinical feature. - Clinical features are symptoms and signs (what the patient experiences or what is observed on examination), whereas X-ray findings are **investigative/imaging findings**. *Abdominal distension* - While abdominal distension is a key clinical feature of intestinal obstruction, it can also occur in other conditions (ascites, pregnancy, obesity, bowel perforation). - **Isolated distension lacks specificity** compared to the combination with vomiting.

Question 1

Which of the following is not an absolute indication for hemodialysis?

Accepted Answer

GI bleeding

Answer

Convulsions

Answer

Pericarditis

Answer

Hyperkalemia of 6.5 mEq/L

Question 2

Subclavian steal syndrome is

Accepted Answer

Reversal of blood flow in the ipsilateral vertebral artery

Answer

Reversal of blood flow in the contralateral carotid artery

Answer

Reversal of blood flow in the contralateral vertebral artery

Answer

B/L reversal of blood flow in vertebral arteries

Question 3

What is the purpose of the Queckenstedt test?

Accepted Answer

Spinal block

Answer

Glomus tumor

Answer

Otosclerosis

Answer

Acoustic neuroma

Question 4

Commotio retinae affects which part of the retina -

Accepted Answer

Posterior pole

Answer

Peripheral retina

Answer

Inferior-nasal part

Answer

Superior-nasal part

Question 5

What condition is associated with copper deposition in the cornea?

Accepted Answer

Wilson's disease

Answer

Keratoglobus

Answer

Keratoconus

Answer

Siderosis

Question 6

Maximum correction of myopia can be done by?

Accepted Answer

LASIK

Answer

Radial keratotomy

Answer

Photorefractive keratectomy

Answer

Orthokeratology

Question 7

At what age can children typically draw a square?

Accepted Answer

5 years

Answer

3 years

Answer

6 years

Answer

7 years

Question 8

Which CT view is best for visualizing paranasal polyps?

Accepted Answer

Coronal view

Answer

Axial view

Answer

Sagittal view

Answer

3D view

Question 9

A chest X-ray shows bilateral lung infiltrates. What is the next best investigation?

Accepted Answer

CT

Answer

Sputum examination

Answer

Bronchoscopy

Answer

Echocardiography

Question 10

Which of the following is the best combination of clinical features of intestinal obstruction?

Accepted Answer

Abdominal distension and vomiting

Answer

Vomiting

Answer

Fluid level in X-ray > 4

Answer

Abdominal distension

NEET-PG 2013

Internal Medicine

Ophthalmology

Pediatrics

Radiology

Surgery