NEET-PG 2013 Practice Questions

Q: Which nerve is not involved in superior orbital fissure syndrome?

1st cranial nerve. ***1st cranial nerve*** - The **olfactory nerve (CN I)** is responsible for the sense of smell [2] and passes through the **cribriform plate** of the ethmoid bone, not the superior orbital fissure. - Due to its distinct pathway, it is not affected in **superior orbital fissure syndrome**. *3rd cranial nerve* - The **oculomotor nerve (CN III)** passes through the superior orbital fissure and is frequently involved in the syndrome. - Its involvement leads to ophthalmoplegia, ptosis, and a dilated pupil due to paralysis of most extrinsic ocular muscles [1], [3] and the parasympathetic fibers [1]. *4th cranial nerve* - The **trochlear nerve (CN IV)** also travels through the superior orbital fissure. - Damage to this nerve causes **diplopia** and impaired downward and intorsion movements of the eye due to paralysis of the **superior oblique muscle** [3]. *6th cranial nerve* - The **abducens nerve (CN VI)** enters the orbit via the superior orbital fissure. - Injury to the abducens nerve results in **lateral rectus muscle** palsy, leading to esotropia (medial deviation of the eye) and impaired abduction [3].

Q: Posterior epistaxis occurs from:

Woodruff's plexus. ***Woodruff's plexus*** - **Woodruff's plexus** is a collection of large, often friable veins located on the **posterior aspect of the lateral wall of the nasal cavity**, making it the most common anatomical site for **posterior epistaxis**. - Bleeding from this plexus is typically more severe and difficult to control than anterior epistaxis due to the larger vessel size and posterior location. - Located in the **posterolateral nasal cavity** near the posterior end of the inferior turbinate. *Kiesselbach's plexus* - **Kiesselbach's plexus** (also known as Little's area) is located on the **anterior nasal septum** and is the most common site for **anterior epistaxis**. - This is an anastomotic network of vessels from multiple arterial sources in the anterior nasal cavity. - Bleeding from this plexus is usually less severe and often responds to local pressure or cauterization. *Sphenopalatine artery* - The **sphenopalatine artery** is the terminal branch of the maxillary artery and is the primary arterial supply to the posterior nasal cavity. - While it supplies the area where posterior epistaxis occurs, the venous **Woodruff's plexus** is the specific anatomical structure most commonly associated with posterior epistaxis. - The sphenopalatine artery may require ligation or embolization in severe posterior epistaxis cases. *Little's area* - **Little's area** is another name for **Kiesselbach's plexus** and is located on the **anterior nasal septum**, primarily responsible for anterior epistaxis. - This area is highly vascularized by anastomoses of the anterior ethmoidal, sphenopalatine, greater palatine, superior labial, and septal branches of arteries. - Prone to bleeding from minor trauma, digital manipulation, or mucosal dryness.

Q: Which of the following is a predisposing factor for nasal myiasis?

Atrophic rhinitis. ***Atrophic rhinitis*** - **Atrophic rhinitis** leads to thinning and drying of the nasal mucosa, creating a favorable environment for **fly larvae (maggots)** to infest. - The **crusting and foul odor** associated with atrophic rhinitis can attract flies, making the nasal cavity susceptible to myiasis. *Allergic rhinitis* - Characterized by **inflammation and watery discharge** due to allergen exposure. It does not create the tissue damage or conducive environment for myiasis. - While it causes nasal symptoms, it generally **does not involve tissue necrosis** or open lesions that would attract flies for oviposition. *Vasomotor rhinitis* - Involves **non-allergic triggers** causing nasal congestion, sneezing, and runny nose, often due to autonomic nervous system dysfunction. - There is **no tissue destruction or mucosal atrophy** that would predispose to myiasis. *Rhinitis medicamentosa* - Results from **overuse of topical decongestant sprays**, leading to rebound congestion and chronic inflammation. - While it causes nasal irritation, it does **not typically involve the extensive mucosal damage or open wounds** that attract flies for myiasis.

Q: A 68-year-old patient presents with sudden onset of right-sided weakness and slurred speech. The symptoms completely resolve within 30 minutes with no residual neurological deficits. This clinical presentation is most consistent with:

Transient Ischemic Attack (TIA). ***Transient Ischemic Attack (TIA)*** - A TIA is characterized by **transient neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia**, without acute infarction [1]. - The key diagnostic feature here is the **complete resolution of symptoms within a short period** (30 minutes) with no residual deficits, fitting the definition of TIA [1]. *Subarachnoid hemorrhage* - This typically presents with a **sudden, severe headache** (often described as "thunderclap"), stiff neck, and altered mental status. - While it can cause sudden neurological deficits, these symptoms usually **do not resolve completely within minutes**, and often lead to persistent deficits or life-threatening complications. *Intracerebral hemorrhage* - An intracerebral hemorrhage involves **bleeding directly into the brain tissue**, leading to sudden onset of neurological deficits that **progress over time** [2]. - The symptoms are generally **severe and persistent**, and would not resolve completely within 30 minutes. *Ischemic stroke* - An ischemic stroke is caused by a **blockage of blood flow to the brain**, resulting in brain tissue damage (infarction) and persistent neurological deficits [2]. - While initial symptoms can be similar to a TIA [3], an ischemic stroke by definition involves **permanent damage and lasting deficits**, unlike what is described in the patient's presentation.

Q: Empyema thoracis is most commonly caused by which organism

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - This is the **most common cause of empyema thoracis**, accounting for **40-70% of all cases** in most published series - It is the leading cause of **community-acquired pneumonia** that progresses to parapneumonic effusion and empyema - The pneumococcal infection leads to **inflammatory exudation** into the pleural space, which can progress through exudative, fibrinopurulent, and organizing phases to form frank empyema - Remains the most frequent causative organism across all age groups in community-acquired empyema *Staphylococcus aureus* - An important but **less common cause** of empyema, accounting for approximately 10-20% of cases - More frequently seen in **specific clinical contexts**: post-influenza pneumonia, hospital-acquired infections, hematogenous spread, and pediatric empyema - Causes **severe, necrotizing infections** with abscess formation and is associated with higher morbidity - While clinically significant, it is **not the most common** overall cause *Pseudomonas* - *Pseudomonas aeruginosa* is primarily associated with **nosocomial empyema** in hospitalized patients - Risk factors include **ventilator-associated pneumonia**, immunosuppression, and **cystic fibrosis** - Accounts for a small percentage of empyema cases overall *Mycobacterium* - *Mycobacterium tuberculosis* causes **tuberculous empyema**, a chronic condition with characteristic **thick pleural fluid** and caseous material - Important in regions with high TB prevalence but represents a distinct entity from acute bacterial empyema - Not a common cause of acute pyogenic empyema in most settings

Q: During retinoscopy of a 30-year-old male, which cycloplegic is used routinely?

Cyclopentolate 1% drop. ***Cyclopentolate 1% drop*** - When cycloplegia is required for retinoscopy, **cyclopentolate 1%** is the preferred agent in adults due to its **rapid onset** (30-60 minutes) and **intermediate duration** (6-24 hours). - It provides adequate **cycloplegia** (paralysis of accommodation) to reveal the full refractive error without the prolonged effects of atropine. - **Clinical note:** In routine practice, most adults aged 30 years undergo retinoscopy **without cycloplegia** as accommodation is usually not a significant factor. Cycloplegia in adults is reserved for specific indications like suspected latent hyperopia, accommodative spasm, or unreliable subjective refraction. *Homatropine 2% drop* - Homatropine has a **slower onset** (1 hour) and **longer duration** (1-3 days) compared to cyclopentolate, making it less practical for routine diagnostic use. - It is typically used for therapeutic purposes such as in **anterior uveitis** to provide cycloplegia and mydriasis. *Atropine 1% ointment* - Atropine is the **strongest** and **longest-acting** cycloplegic with effects lasting **7-14 days**, which is excessively long for diagnostic retinoscopy. - It is primarily used in **young children** (especially under 5 years) for accurate refraction and in therapeutic settings for **cycloplegic refraction in amblyopia** treatment. *None of the options* - While it's true that **routine retinoscopy in a healthy 30-year-old adult** typically does NOT require cycloplegia, this question asks which cycloplegic would be used **when indicated**. - Among the available cycloplegic options, **cyclopentolate** remains the appropriate choice for adults when cycloplegia is deemed necessary.

Q: Surgery of choice for chronic acquired dacryocystitis

Dacryocystorhinostomy. ***Dacryocystorhinostomy*** - This procedure creates a new connection between the **lacrimal sac** and the **nasal cavity**, bypassing the obstructed nasolacrimal duct. - It is the **surgery of choice** for chronic acquired dacryocystitis as it provides a permanent solution for tear drainage. *Dacryocystectomy* - This involves **excision of the lacrimal sac**, which can relieve symptoms of infection but eliminates the sac's function. - It is generally reserved for cases where dacryocystorhinostomy is contraindicated or has failed, and is **not the primary choice** for restoring tear flow. *Conjunctivo-cystorhinostomy* - This procedure creates a bypass from the **conjunctiva** directly to the **nasal cavity**, typically used when the canaliculi are also obstructed. - It is a more complex surgery indicated for **proximal lacrimal system obstruction** (e.g., canalicular block) rather than isolated nasolacrimal duct obstruction. *None of the options* - **Dacryocystorhinostomy** is the well-established and most effective surgical intervention for chronic acquired dacryocystitis. - Therefore, this option is incorrect as there is a suitable surgical choice available.

Q: At which anatomical location is the opening created in dacryocystorhinostomy?

Middle meatus. ***Middle meatus*** - In **dacryocystorhinostomy (DCR)**, the anastomosis is created between the **lacrimal sac** and the nasal cavity at the level of the **middle meatus**. - The lacrimal sac is located **lateral to the middle turbinate**, making this the anatomically appropriate site for creating the surgical opening. - This placement allows direct drainage of tears from the lacrimal sac into the nasal cavity, **bypassing the obstructed nasolacrimal duct**. - The **middle meatus** provides optimal access and physiological tear drainage. *Inferior meatus* - The **nasolacrimal duct** naturally drains into the **inferior meatus** under normal anatomy. - However, DCR is performed to **bypass** an obstructed nasolacrimal duct, so the anastomosis is created more **superiorly** at the lacrimal sac level. - The inferior meatus is **below** the level of the lacrimal sac and would not provide direct access to it. *Superior meatus* - The **superior meatus** is located above the superior turbinate and receives drainage from the **posterior ethmoidal sinuses**. - This location is **too superior** for DCR and does not correspond to the anatomical position of the lacrimal sac. *Sphenoethmoidal recess* - The **sphenoethmoidal recess** is the most superior and posterior area, receiving drainage from the **sphenoid sinus**. - This location is far too **superior and posterior** to be used for lacrimal drainage surgery.

Q: Which of the following is NOT a complication of elbow dislocation?

Radial nerve injury. ***Radial nerve injury*** - The **radial nerve** is rarely injured in an elbow dislocation due to its anatomical course, which is less exposed to the shearing forces involved in this type of injury. - While other nerves like the ulnar and median nerves are more susceptible, significant stretching or compression of the radial nerve is **uncommon** in typical elbow dislocations. *Vascular injury* - The **brachial artery** runs in close proximity to the elbow joint and can be torn or compressed during a dislocation, leading to **ischemia** if not promptly recognized and treated. - This complication can result in **Volkmann's ischemic contracture** if perfusion is not restored. *Median nerve injury* - The **median nerve** passes anterior to the elbow joint and is vulnerable to injury from stretching or direct compression during dislocation. - Injury can manifest as **sensory deficits** in the distribution of the median nerve and **weakness** of forearm pronation and thumb flexion/opposition. *Myositis ossificans* - This is a common chronic complication of elbow dislocations, particularly in cases of **delayed reduction** or aggressive physical therapy. - It involves the **abnormal ossification** of soft tissues around the joint, commonly in the brachialis muscle, leading to **pain and restricted range of motion**.

Q: The most common cause of acquired AV fistula is:

Penetrating trauma. ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.

Question 1

Which nerve is not involved in superior orbital fissure syndrome?

Accepted Answer

1st cranial nerve

Answer

3rd cranial nerve

Answer

4th cranial nerve

Answer

6th cranial nerve

Question 2

Posterior epistaxis occurs from:

Accepted Answer

Woodruff's plexus

Answer

Kiesselbach's plexus

Answer

Sphenopalatine artery

Answer

Little's area

Question 3

Which of the following is a predisposing factor for nasal myiasis?

Accepted Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Answer

Vasomotor rhinitis

Answer

Rhinitis medicamentosa

Question 4

A 68-year-old patient presents with sudden onset of right-sided weakness and slurred speech. The symptoms completely resolve within 30 minutes with no residual neurological deficits. This clinical presentation is most consistent with:

Accepted Answer

Transient Ischemic Attack (TIA)

Answer

Subarachnoid hemorrhage

Answer

Intracerebral hemorrhage

Answer

Ischemic stroke

Question 5

Empyema thoracis is most commonly caused by which organism

Accepted Answer

Streptococcus pneumoniae

Answer

Pseudomonas

Answer

Staphylococcus aureus

Answer

Mycobacterium

Question 6

During retinoscopy of a 30-year-old male, which cycloplegic is used routinely?

Accepted Answer

Cyclopentolate 1% drop

Answer

Homatropine 2% drop

Answer

Atropine 1% ointment

Answer

None of the options

Question 7

Surgery of choice for chronic acquired dacryocystitis

Accepted Answer

Dacryocystorhinostomy

Answer

Dacryocystectomy

Answer

Conjunctivo-cystorhinostomy

Answer

None of the options

Question 8

At which anatomical location is the opening created in dacryocystorhinostomy?

Accepted Answer

Middle meatus

Answer

Superior meatus

Answer

Sphenoethmoidal recess

Answer

Inferior meatus

Question 9

Which of the following is NOT a complication of elbow dislocation?

Accepted Answer

Radial nerve injury

Answer

Vascular injury

Answer

Median nerve injury

Answer

Myositis ossificans

Question 10

The most common cause of acquired AV fistula is:

Accepted Answer

Penetrating trauma

Answer

Bacterial infection

Answer

Fungal infection

Answer

Blunt trauma

NEET-PG 2013

Anatomy

ENT

Internal Medicine

Microbiology

Ophthalmology

Orthopaedics

Surgery