NEET-PG 2013 Practice Questions

Q: What is the characteristic feature of ethmoidal polyps?

Typically recurrent. ***Typically recurrent*** - Ethmoidal polyps, especially those associated with **chronic rhinosinusitis** with nasal polyps, have a high tendency to **recur** even after surgical removal. - This recurrence is due to the underlying inflammatory process in the ethmoid sinuses and represents their most characteristic clinical feature. - Recurrence rates can reach **20-30%** even after functional endoscopic sinus surgery (FESS). *Usually multiple* - While ethmoidal polyps are often **multiple**, this is a common descriptive feature rather than their most characteristic pathological tendency. - Their multiplicity contributes to nasal obstruction and other symptoms but does not distinguish them as uniquely as their recurrence rate. *Can occur in children* - Though less common than in adults, **ethmoidal polyps can occur in children**, particularly in association with conditions like cystic fibrosis or primary ciliary dyskinesia. - However, nasal polyps in children are **rare** and should prompt investigation for underlying systemic conditions. *Can be associated with infections* - While chronic rhinosinusitis with polyps can be complicated by **bacterial infections**, the polyps themselves are primarily an inflammatory response, not directly caused by infections in most cases of ethmoidal polyps. - Their primary association is with chronic inflammation and not solely with acute or chronic infections.

Q: All are intracranial complications of otitis media except which of the following?

Facial nerve palsy. ***Facial nerve palsy*** - This is an **extracranial complication** of otitis media affecting the **facial nerve within the temporal bone**, not an intracranial structure. - The facial nerve (CN VII) runs through the **fallopian canal** in the temporal bone and can be affected by inflammation from adjacent mastoid or middle ear infection. - Classified as a **temporal bone complication** rather than an intracranial complication. *Lateral sinus thrombophlebitis* - This is a true **intracranial complication** involving thrombosis of the **sigmoid and lateral venous sinuses** within the cranial cavity. - Results from direct extension of infection through the **mastoid tegmen** or via septic thrombophlebitis. - Presents with features of sepsis, headache, and papilledema. *Brain abscess* - A severe **intracranial complication** representing focal suppurative infection within the **brain parenchyma** (commonly temporal lobe or cerebellum). - Occurs through direct extension via bony erosion, retrograde thrombophlebitis, or hematogenous spread. - Requires urgent neurosurgical intervention. *Hydrocephalus* - An **intracranial complication** that can occur secondary to **otogenic meningitis** or **lateral sinus thrombosis**. - Results from impaired CSF absorption or obstruction of CSF pathways. - More common in pediatric otitis media with CNS complications.

Q: In otosclerosis, which structure is primarily affected?

Foot plate of stapes. ***Foot plate of stapes*** - Otosclerosis is a disease of the **temporal bone** that causes abnormal bone growth, primarily affecting the footplate of the stapes. - This abnormal bone growth leads to the **fixation of the stapes** in the oval window, impairing sound conduction and causing **conductive hearing loss**. *Oval window* - While the oval window is the location where the stapes articulates, otosclerosis specifically affects the **footplate of the stapes**, causing it to become fixed within the oval window. - The oval window itself is a structure of the inner ear, but the primary pathology involves the **stapes bone**. *Round window* - The round window plays a role in relieving pressure in the **cochlea** by bulging outwards when the oval window bulges inwards. - It is **not directly affected** by the abnormal bone growth characteristic of otosclerosis. *Utricle* - The utricle is a part of the **vestibular system** in the inner ear, responsible for sensing linear acceleration and head tilt. - It is **not involved** in the pathogenesis of otosclerosis, which is primarily a conductive hearing loss disorder.

Q: What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?

Rebreathing in paper bag. ***Rebreathing in paper bag*** - This helps to **increase the inspired CO2 concentration**, thereby correcting the hypocapnia (low CO2) caused by hyperventilation. - It's a simple, non-invasive method to raise arterial PCO2 and normalize blood pH in acute respiratory alkalosis. *IPPV* - **Intermittent positive pressure ventilation (IPPV)** would further reduce CO2 by assisting ventilation and is typically used for respiratory *acidosis* or failure [1]. - This intervention would worsen the patient's respiratory alkalosis rather than alleviating it. *Normal saline* - **Normal saline** administration is primarily used for volume expansion or to correct electrolyte imbalances; it does not directly address respiratory alkalosis. - It would not correct the underlying issue of excessive CO2 exhalation. *Acetazolamide* - **Acetazolamide** is a carbonic anhydrase inhibitor that reduces bicarbonate reabsorption and is used to treat metabolic alkalosis or as a diuretic. - It would not be an immediate or appropriate solution for acute respiratory alkalosis and might even worsen the acid-base balance if used improperly.

Q: In inflammatory myopathy, which group of muscles is not affected

Ocular. ***Ocular*** - The **extraocular muscles** responsible for eye movement are generally spared in typical inflammatory myopathies, distinguishing them from other neuromuscular disorders. - Inflammatory myopathies primarily affect **skeletal muscles**, but **ocular muscles** have unique immunological and physiological properties that often protect them. *Facial* - While less commonly affected early in the disease, some inflammatory myopathies, particularly **dermatomyositis**, can eventually involve **facial muscles**, leading to weakness. - Involvement of **facial muscles** can manifest as difficulty with smiling, whistling, or closing the eyelids. *Proximal muscles of limb* - Inflammatory myopathies characteristically cause **proximal muscle weakness**, affecting muscles of the **shoulders, hips, and thighs** [1]. - This weakness often presents as difficulty climbing stairs, getting up from a chair, or lifting objects overhead [1]. *Distal muscles of limb* - While less common than proximal involvement, **distal muscle weakness** (affecting hands and feet) can occur in some subsets of inflammatory myopathies, such as **inclusion body myositis**. - This can lead to difficulties with fine motor tasks or foot drop.

Q: The most common cause of meningitis in children aged 5 yrs is-

S. pneumoniae. ***S. pneumoniae*** - **_Streptococcus pneumoniae_** (Pneumococcus) is the **most common cause of bacterial meningitis** in children aged 5 years and older, as well as in adults. - Widespread vaccination has reduced its incidence but it remains a significant pathogen. *H. influenzae* - **_Haemophilus influenzae_ type b (Hib)** was a major cause of meningitis in young children, but its incidence has **drastically decreased** due to the routine **Hib vaccine**. - Without vaccination, it would still be a significant cause in this age group, but with high vaccine coverage, it is less common than _S. pneumoniae_. *Staphylococcus* - **_Staphylococcus aureus_** and other staphylococcal species are **less common causes of meningitis** in otherwise healthy children. - They are more typically associated with meningitis following **neurosurgery**, trauma, or in immunocompromised patients. *E.coli* - **_Escherichia coli_** is a common cause of **neonatal meningitis** (in infants less than 3 months old), often acquired during passage through the birth canal. - It is **rarely a cause of meningitis** in children aged 5 years.

Q: Stocker's line is seen in?

Pterygium. **Pterygium** - **Stocker's line** is a **ferrous deposit** that appears as a brown or yellow line at the leading edge of a **pterygium**. - Its presence signifies the progressive nature of the pterygium, indicating ongoing iron deposition due to chronic epithelial degeneration and remodeling. *Glaucoma* - Glaucoma is characterized by **optic nerve damage** and **visual field loss**, usually associated with elevated intraocular pressure. - It does not involve the formation of Stocker's line, which is a corneal or conjunctival finding. *Posterior scleritis* - Posterior scleritis is an **inflammation of the sclera** behind the equator of the globe, often presenting with pain, vision loss, or choroidal folds. - It does not involve the characteristic Stocker's line, which is specific to pterygium. *Diabetic retinopathy* - Diabetic retinopathy involves **microvascular damage** to the retina, leading to vision loss, and is characterized by microaneurysms, hemorrhages, and neovascularization. - It is a retinal disease and does not present with Stocker's line.

Q: Which of the following statements about Fuchs' corneal dystrophy is incorrect?

Unilateral condition. ***Unilateral condition - INCORRECT STATEMENT*** - **Fuchs' corneal dystrophy** is typically a **bilateral condition**, although it can be asymmetric in its presentation. - The disease often affects both eyes, progressing from early morning blurriness to constant visual impairment. - This is the INCORRECT statement - Fuchs' is NOT unilateral. *Posterior dystrophy - Correct statement* - **Fuchs' corneal dystrophy** is classified as a posterior corneal dystrophy, meaning it primarily affects the **corneal endothelium** and Descemet's membrane. - This posterior involvement leads to the characteristic guttata and corneal edema. *Endothelial dystrophy - Correct statement* - It is fundamentally an **endothelial dystrophy**, resulting from primary dysfunction and loss of corneal endothelial cells. - The compromised endothelial pump function leads to **stromal edema** and reduced visual acuity. *Occurs in old age - Correct statement* - Fuchs' corneal dystrophy typically presents in **middle to old age**, with symptoms often becoming noticeable in individuals over 50. - While congenital forms of corneal dystrophy exist, Fuchs' is not usually one of them.

Q: Most common syndrome associated with A-V canal defect -

Down syndrome. ***Down syndrome*** - **Down syndrome (Trisomy 21)** is the most common syndrome associated with **atrioventricular (AV) canal defects** (endocardial cushion defects) - Occurs in approximately **40-50% of individuals with Down syndrome**, making it the hallmark cardiac anomaly in this condition - AV canal defects range from partial to complete defects involving atrial and ventricular septa and AV valves *Klinefelter syndrome* - **Klinefelter syndrome (47,XXY)** is not characteristically associated with AV canal defects - May have **mitral valve prolapse** or **aortic root dilation**, but AV canal defects are not a typical feature *Turner syndrome* - **Turner syndrome (45,X)** has distinct cardiovascular associations including **coarctation of the aorta** and **bicuspid aortic valve** - AV canal defects are **not** characteristic of Turner syndrome *Marfan syndrome* - **Marfan syndrome** is a connective tissue disorder with **aortic root dilation**, **aortic aneurysms**, and **mitral valve prolapse** - **AV canal defects are not a feature** of Marfan syndrome

Q: Which of the following drugs is useful in acute attack of gout ?

Piroxicam. ***Piroxicam*** - **Piroxicam** is a **non-steroidal anti-inflammatory drug (NSAID)**, which are the first-line treatment for acute gout attacks. - NSAIDs work by inhibiting **prostaglandin synthesis**, thereby reducing inflammation and pain associated with the acute crystal-induced arthritis. *Furosemide* - **Furosemide** is a loop diuretic that can **raise uric acid levels** by increasing reabsorption in the renal tubules. - Therefore, it would exacerbate **gout** and is contraindicated during an acute attack. *Sulfinpyrazone* - **Sulfinpyrazone** is a **uricosuric agent** used for chronic gout management to increase uric acid excretion. - It is **not used for acute attacks** as it can precipitate or worsen an attack by mobilizing uric acid crystals. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used for long-term management of hyperuricemia and chronic gout. - Starting allopurinol during an **acute attack** can worsen or prolong the attack by causing rapid changes in serum uric acid levels.

Question 1

What is the characteristic feature of ethmoidal polyps?

Accepted Answer

Typically recurrent

Answer

Usually multiple

Answer

Can occur in children

Answer

Can be associated with infections

Question 2

All are intracranial complications of otitis media except which of the following?

Accepted Answer

Facial nerve palsy

Answer

Brain abscess

Answer

Hydrocephalus

Answer

Lateral sinus thrombophlebitis

Question 3

In otosclerosis, which structure is primarily affected?

Accepted Answer

Foot plate of stapes

Answer

Round window

Answer

Utricle

Answer

Oval window

Question 4

What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?

Accepted Answer

Rebreathing in paper bag

Answer

IPPV

Answer

Normal saline

Answer

Acetazolamide

Question 5

In inflammatory myopathy, which group of muscles is not affected

Accepted Answer

Ocular

Answer

Facial

Answer

Proximal muscles of limb

Answer

Distal muscles of limb

Question 6

The most common cause of meningitis in children aged 5 yrs is-

Accepted Answer

S. pneumoniae

Answer

Staphylococcus

Answer

E.coli

Answer

H. influenzae

Question 7

Stocker's line is seen in?

Accepted Answer

Pterygium

Answer

Glaucoma

Answer

Posterior scleritis

Answer

Diabetic retinopathy

Question 8

Which of the following statements about Fuchs' corneal dystrophy is incorrect?

Accepted Answer

Unilateral condition

Answer

Endothelial dystrophy

Answer

Occurs in old age

Answer

Posterior dystrophy

Question 9

Most common syndrome associated with A-V canal defect -

Accepted Answer

Down syndrome

Answer

Klinefelter syndrome

Answer

Turner syndrome

Answer

Marfan syndrome

Question 10

Which of the following drugs is useful in acute attack of gout ?

Accepted Answer

Piroxicam

Answer

Furosemide

Answer

Sulfinpyrazone

Answer

Allopurinol

NEET-PG 2013

ENT

Internal Medicine

Microbiology

Ophthalmology

Pediatrics

Pharmacology