NEET-PG 2013 Practice Questions

Q: Upper Lid Retractors include

Levator palpebrae superioris & Muller muscle. ***Levator palpebrae superioris & Muller muscle*** - The **levator palpebrae superioris (LPS)** is the primary muscle responsible for lifting the upper eyelid. It is a striated muscle innervated by the oculomotor nerve (CN III). - **Müller's muscle** (also known as the superior tarsal muscle) is a smooth muscle that provides an additional, sustained lift to the upper eyelid. It is sympathetically innervated. *Muller muscle and superior rectus* - While **Müller's muscle** is an upper lid retractor, the **superior rectus** muscle primarily acts to elevate and adduct the eyeball, not the eyelid itself [1]. - The superior rectus muscle has only a minor, indirect role in upper eyelid elevation through its connection with the LPS aponeurosis. *Levator palpabrae superioris and superior oblique* - The **levator palpebrae superioris (LPS)** is a key upper lid retractor. - However, the **superior oblique** muscle is involved in depressing and intorting the eyeball [1], and has no direct role in upper eyelid retraction. *Superior oblique and superior rectus* - Neither the **superior oblique** nor the **superior rectus** muscles are primary upper lid retractors. - The superior oblique depresses and intorts the eye, while the superior rectus elevates and adducts the eye [1]. Both are extrinsic ocular muscles.

Q: Most common bone affected by otosclerosis?

Stapes. ***Stapes*** - **Otosclerosis** is characterized by abnormal bone remodeling in the otic capsule, primarily affecting the **stapes footplate**. - This leads to its fixation in the oval window, causing **conductive hearing loss**. - The **stapediovestibular joint** is the most common site, occurring in over 90% of cases. *Bony labyrinth* - While otosclerosis originates in the **otic capsule** (which forms the bony labyrinth), the term refers to a broader anatomical structure. - The specific site of clinical significance is the **stapes footplate**, not the labyrinth as a whole. *Mastoid process* - The **mastoid process** is part of the temporal bone but is structurally distinct from the middle ear and otic capsule. - It is not involved in otosclerosis pathology. *Incus* - While the **incus** is a middle ear ossicle, it is rarely affected by otosclerosis. - The disease process specifically targets the **stapes footplate** at the oval window, not other ossicles.

Q: What is the preferred method for removing a foreign body from the lung in children?

Rigid bronchoscopy. ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.

Q: Down beat nystagmus is seen in?

Arnold Chiari malformation and other conditions. ***Arnold Chiari malformation and other conditions*** - Downbeat nystagmus is a characteristic finding in Arnold-Chiari malformations, especially **Chiari type 1**, due to compression of cerebellar structures. - Other conditions associated with downbeat nystagmus include **medullary lesions**, **magnesium deficiency**, and **lithium toxicity** [1]. *Brain stem lesions* - While brainstem lesions can cause various nystagmus types, **pure downbeat nystagmus** is less commonly the primary or most specific finding compared to cerebellar involvement [1]. - **Upbeat nystagmus** and other complex nystagmus patterns are more often associated with brainstem lesions like those in the tegmentum. *Pontine hemorrhage and other conditions* - Pontine hemorrhages are more commonly associated with **ocular bobbing**, **blink reflex abnormalities**, or **horizontal gaze palsies**, rather than downbeat nystagmus. - A pontine hemorrhage would typically present with more severe neurological deficits such as **coma** or **quadriparesis**, which are not directly associated with isolated nystagmus. *Labyrinthine damage and other conditions* - **Peripheral vestibular abnormalities** from labyrinthine damage typically cause **horizontal or torsional nystagmus**, often suppressed by visual fixation. - Downbeat nystagmus is a **central vestibular sign**, indicating a problem with central vestibular processing rather than the peripheral labyrinth [1].

Q: Most common hematological malignancy associated with Rheumatoid Arthritis (RA)?

Large granular lymphocytic leukemia (LGLL). ***Large granular lymphocytic leukemia (LGLL)*** - **LGLL** is the most common hematological malignancy strongly associated with **rheumatoid arthritis (RA)**, often presenting with features such as **neutropenia** and splenomegaly. - Approximately 80% of patients with LGLL have a **T-cell phenotype**, and a significant subset experiences **autoimmune diseases**, with RA being the most frequent. *Diffuse large B cell lymphoma* - While patients with **RA** have an increased risk of **lymphoma**, **diffuse large B-cell lymphoma (DLBCL)** is a more aggressive type but not the most common hematologic malignancy directly associated with the disease itself in terms of prevalence [3]. - Inflammatory conditions like **RA** can contribute to chronic immune stimulation, increasing the risk of certain lymphomas, but LGLL holds a more direct and prevalent association [1]. *Chronic lymphocytic leukemia* - **Chronic lymphocytic leukemia (CLL)** is a lymphoproliferative disorder of **B lymphocytes**, but it does not have a particularly strong or common association with **RA** compared to LGLL [2]. - The elevated risk of hematological malignancies in RA patients typically points more towards lymphoproliferative disorders driven by specific immune dysregulations characteristic of RA. *T-cell prolymphocytic leukemia* - **T-cell prolymphocytic leukemia (T-PLL)** is a rare and aggressive **T-cell leukemia** that generally presents with a high white blood cell count and splenomegaly, but it is not commonly linked with **RA**. - Its clinical presentation and biology are distinct from the more indolent leukemias like LGLL that are often seen in conjunction with autoimmune conditions.

Q: In the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?

Grey Turner's sign. ***Grey Turner's sign*** - This sign refers to **bluish discoloration of the flank** due to **hemorrhage** into the retroperitoneal space, commonly seen in severe hemorrhagic pancreatitis. [1] - The discoloration is caused by **peripancreatic inflammation** and fat necrosis, leading to localized bleeding. *Cullen's sign* - Cullen's sign is characterized by **bluish discoloration around the umbilicus**. - It is also indicative of **retroperitoneal hemorrhage**, but specifically in the periumbilical region. *Trousseau's sign* - This sign refers to **carpal spasm** induced by inflating a blood pressure cuff above systolic pressure for several minutes. - It is indicative of **hypocalcemia**, not hemorrhage, and is seen in conditions like pancreatitis that cause low calcium levels. *None of the options* - This option is incorrect because **Grey Turner's sign** specifically describes the bluish discoloration of the flank associated with hemorrhagic pancreatitis.

Q: Van Herick angle grade '3' of anterior chamber denotes

Moderately open angle. ***Moderately open angle*** - A **Von Herick angle grade 3** indicates that the width of the peripheral anterior chamber is approximately **one-quarter to one-half** the thickness of the peripheral cornea. - This assessment suggests a **moderately open anterior chamber angle**, indicating that while there is some risk of angle closure, it is not immediately narrow. *Wide open angle* - A **wide open angle** is typically represented by a **Von Herick grade 4**, where the anterior chamber angle is as wide or wider than the corneal thickness. - This grade signifies a **low risk of angle closure** and good aqueous outflow. *Narrow angle* - A **narrow angle** is generally associated with **Von Herick grades 1 or 2**, where the anterior chamber is significantly shallower. - Grade 1 indicates an angle width of **less than one-quarter** of peripheral corneal thickness, posing a higher risk of angle closure. *Closed angle* - A **closed angle** represents an extreme case where the **iris is in contact with the trabecular meshwork**, blocking aqueous outflow. - This condition is not typically graded in the Von Herick system as an existent angle, but rather as an absence of a visible angle (grade 0 or **"slit"**).

Q: A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?

Ketoconazole. ***Ketoconazole*** - **Ketoconazole** is an antifungal agent that also inhibits several enzymes involved in **steroidogenesis**, including 17α-hydroxylase and 11β-hydroxylase. - This action helps to reduce the overproduction of **cortisol** in Cushing syndrome caused by an adrenal tumor. *Hydrocortisone* - **Hydrocortisone** is a glucocorticoid itself and would exacerbate the symptoms of **Cushing syndrome** by adding to the already elevated cortisol levels. - It is used for **cortisol replacement therapy** in conditions like Addison's disease, where cortisol levels are low. *Dexamethasone* - **Dexamethasone** is a potent synthetic glucocorticoid used to suppress **ACTH production** in cases of ACTH-dependent Cushing's syndrome (e.g., Cushing's disease) or to diagnose Cushing's syndrome. - In an adrenal tumor, which is **ACTH-independent**, dexamethasone would not reduce cortisol production but could instead worsen the hypercortisolism. *Spironolactone* - **Spironolactone** is an **aldosterone antagonist** and a weak antiandrogen, primarily used for conditions like hyperaldosteronism, heart failure, and hirsutism. - It has no direct effect on the overproduction of **cortisol** from an adrenal tumor in Cushing syndrome.

Q: Best approach for emergency thoracotomy in acute thoracic trauma is

Anterolateral thoracotomy. ***Anterolateral thoracotomy*** - Provides **rapid access** to the chest cavity for emergent situations, such as **cardiac tamponade** or **massive hemorrhage**, which are common in thoracic trauma. - Allows assessment and management of injuries to the **heart, great vessels, and lungs** with minimal repositioning in a critically ill patient. *Midline sternotomy* - Primarily used for **cardiac surgery**, offering excellent exposure to the mediastinum but is less ideal for general thoracic trauma with potential lateral injuries. - Takes **longer to perform** than an anterolateral approach and may not be suitable in an emergent, unstable trauma setting. *Parasternal thoracotomy* - Offers more limited access compared to other approaches, typically used for specific, localized procedures near the sternum. - Does not provide the **broad exposure** needed to manage the diverse and potentially widespread injuries seen in severe thoracic trauma. *Posterolateral thoracotomy* - Provides excellent exposure to the **posterior mediastinum, spine, and descending aorta**, but requires the patient to be in the lateral decubitus position. - Repositioning a severely injured trauma patient for this approach is often **impractical and time-consuming**, making it unsuitable for initial resuscitation.

Question 1

Upper Lid Retractors include

Accepted Answer

Levator palpebrae superioris & Muller muscle

Answer

Muller muscle and superior rectus

Answer

Levator palpebrae superioris and superior oblique

Answer

Superior oblique and superior rectus

Question 2

Most common bone affected by otosclerosis?

Accepted Answer

Stapes

Answer

Bony labyrinth

Answer

Mastoid process

Answer

Incus

Question 3

What is the preferred method for removing a foreign body from the lung in children?

Accepted Answer

Rigid bronchoscopy

Answer

Chest x-ray

Answer

Flexible endoscopy

Answer

Direct laryngoscopy

Question 4

Down beat nystagmus is seen in?

Accepted Answer

Arnold Chiari malformation and other conditions

Answer

Brain stem lesions

Answer

Pontine hemorrhage and other conditions

Answer

Labyrinthine damage and other conditions

Question 5

Most common hematological malignancy associated with Rheumatoid Arthritis (RA)?

Accepted Answer

Large granular lymphocytic leukemia (LGLL)

Answer

Diffuse large B cell lymphoma

Answer

Chronic lymphocytic leukemia

Answer

T-cell prolymphocytic leukemia

Question 6

In the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?

Accepted Answer

Grey Turner's sign

Answer

Cullen's sign

Answer

Trousseau's sign

Answer

None of the options

Question 7

Van Herick angle grade '3' of anterior chamber denotes

Accepted Answer

Moderately open angle

Answer

Wide open angle

Answer

Closed angle

Answer

Narrow angle

Question 8

A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?

Accepted Answer

Ketoconazole

Answer

Spironolactone

Answer

Hydrocortisone

Answer

Dexamethasone

Question 9

Coronary steal phenomenon caused due to

Accepted Answer

Preferential vasodilation of normal coronary vessels over stenotic vessels

Answer

Dilation of large coronary arteries

Answer

Dilation of epicardial coronary vessels

Answer

Dilation of capacitance vessels

Question 10

Best approach for emergency thoracotomy in acute thoracic trauma is

Accepted Answer

Anterolateral thoracotomy

Answer

Midline sternotomy

Answer

Parasternal thoracotomy

Answer

Posterolateral thoracotomy

NEET-PG 2013

Anatomy

ENT

Internal Medicine

Ophthalmology

Pharmacology

Physiology

Surgery