ENT
1 questionsPosterosuperior retraction pocket if allowed to progress will lead to?
NEET-PG 2013 - ENT NEET-PG Practice Questions and MCQs
Question 1011: Posterosuperior retraction pocket if allowed to progress will lead to?
- A. SNHL
- B. Secondary cholesteatoma
- C. Primary cholesteatoma (Correct Answer)
- D. Tympanosclerosis
Explanation: ***Primary cholesteatoma*** - A posterosuperior retraction pocket is a common precursor to the development of a **primary cholesteatoma**. - This pocket, formed by **negative pressure** in the middle ear, accumulates **desquamated keratin** and can erode surrounding bone. *SNHL* - While a cholesteatoma can ultimately cause **sensorineural hearing loss (SNHL)** due to extensive bone erosion affecting the inner ear, it is a later complication, not the direct outcome of the initial retraction pocket itself. - **SNHL** is more commonly associated with conditions directly damaging the **cochlea or auditory nerve**. *Secondary cholesteatoma* - A **secondary cholesteatoma** typically arises from a perforation in the tympanic membrane where skin migrates into the middle ear, not from an intact retraction pocket. - This condition is also known as a **'migratory'** or **'acquired'** cholesteatoma. *Tympanosclerosis* - **Tympanosclerosis** involves the formation of **hyalinized collagen and calcium deposits** within the tympanic membrane or middle ear mucosa, resulting from chronic inflammation or previous trauma. - It is a **fibrotic healing response** and does not directly result from a retraction pocket, although both can be sequelae of chronic otitis media.
Ophthalmology
6 questionsBirdshot retinopathy is characterized by all except?
What condition is characterized by an "umbrella" configuration on fluorescein angiography?
Which of the following is NOT a feature of CMV retinitis?
Which of the following is not a cause of exudative retinal detachment?
What are the characteristic features of Posner-Schlossman syndrome?
What is the first-line treatment for acute angle closure glaucoma?
NEET-PG 2013 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 1011: Birdshot retinopathy is characterized by all except?
- A. Common in females
- B. Creamy yellow spots
- C. HLA-A29 positive
- D. Unilateral (Correct Answer)
Explanation: ***Unilateral*** - **Birdshot retinopathy** is characteristically a **bilateral** inflammatory condition affecting both eyes, even if the onset may be asymmetric. - The disease involves widespread inflammation of the **choroid** and **retina**, typically presenting in both eyes simultaneously or sequentially. - Unilateral presentation would be highly atypical and should prompt consideration of alternative diagnoses. *Common in females* - Birdshot retinopathy shows a **clear female predominance**, with approximately **2-3 times more females affected than males** (60-75% of cases). - This demographic trend is a well-established feature of the disease. - However, it does occur in both sexes and is still considered characteristic of the condition. *HLA-A29 positive* - A strong association with the **HLA-A29 allele** is a hallmark of birdshot retinopathy, found in **over 95% of affected individuals**. - This genetic marker is highly specific and often used to support the diagnosis. - HLA-A29 testing is considered part of the diagnostic workup. *Creamy yellow spots* - The presence of characteristic **creamy yellow-white choroidal lesions**, resembling birdshot scatter, is a defining clinical feature. - These lesions are typically located in the **mid-peripheral and posterior fundus**, distributed radially around the optic disc. - The "birdshot" appearance refers to the scattered pattern resembling shotgun pellet distribution.
Question 1012: What condition is characterized by an "umbrella" configuration on fluorescein angiography?
- A. Retinitis pigmentosa
- B. Rhegmatogenous retinal detachment
- C. Central serous retinopathy (Correct Answer)
- D. Eale's disease
Explanation: ***Central serous retinopathy*** - The "umbrella" or "smokestack" configuration on **fluorescein angiography** is a classic finding in central serous retinopathy, indicating leakage of dye creating a mushroom-shaped plume. - This leakage originates from the **retinal pigment epithelium (RPE)** into the subretinal space, causing serous detachment of the neurosensory retina. *Retinitis pigmentosa* - Characterized by **progressive photoreceptor degeneration** and **pigmentary changes** in the retina, often described as "bone-spicule" pigmentation. - Fluorescein angiography in retinitis pigmentosa typically shows **atrophy** and **window defects**, not an umbrella pattern of leakage. *Rhegmatogenous retinal detachment* - Involves a **full-thickness break in the retina** that allows vitreous fluid to pass into the subretinal space, causing the retina to detach. - Fluorescein angiography is generally not used for primary diagnosis and would not show an umbrella pattern, but rather **non-perfusion** or vascular changes in the detached area. *Eale's disease* - A rare **idiopathic obliterative periphlebitis** primarily affecting the retinal veins, leading to recurrent vitreous hemorrhages and retinal neovascularization. - Fluorescein angiography would reveal **vascular sheathing**, **non-perfusion**, and **neovascularization**, which are distinct from the umbrella configuration.
Question 1013: Which of the following is NOT a feature of CMV retinitis?
- A. Perivasculitis
- B. Brush-fire appearance
- C. Immunosuppression
- D. Cracked mud appearance (Correct Answer)
Explanation: ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.
Question 1014: Which of the following is not a cause of exudative retinal detachment?
- A. Scleritis
- B. Toxemia of pregnancy
- C. High myopia (Correct Answer)
- D. Central serous retinopathy
Explanation: ***High myopia*** - **High myopia** is a risk factor for **rhegmatogenous retinal detachment**, which is caused by a retinal break, not by fluid accumulation from a vascular or inflammatory process. - In rhegmatogenous detachment, vitreous fluid passes through the break into the subretinal space, separating the **neurosensory retina** from the **retinal pigment epithelium**. *Toxemia of pregnancy* - **Toxemia of pregnancy** (preeclampsia/eclampsia) can cause **exudative retinal detachment** due to choroidal ischemia and dysfunction of the retinal pigment epithelium, leading to fluid leakage. - The elevated **blood pressure** and systemic vascular changes impair choroidal perfusion, resulting in serous fluid accumulation beneath the retina. *Scleritis* - **Posterior scleritis** can lead to **exudative retinal detachment** by causing inflammation and edema of the choroid and sclera, which in turn compromises the integrity of the retinal pigment epithelium. - The inflammatory process increases vascular permeability, allowing fluid to leak into the subretinal space. *Central serous retinopathy* - **Central serous retinopathy** is a classic example of **exudative retinal detachment**, characterized by serous fluid accumulation under the macula. - This occurs due to dysfunction or a break in the **retinal pigment epithelium**, often associated with stress and corticosteroid use, leading to fluid leakage from the choroid.
Question 1015: What are the characteristic features of Posner-Schlossman syndrome?
- A. Ipsilateral optic atrophy with contralateral papilloedema
- B. Unilateral glaucomatous changes with mild anterior uveitis (Correct Answer)
- C. Granulomatous uveitis with iris heterochromia
- D. None of the options
Explanation: ***Unilateral glaucomatous changes with mild anterior uveitis*** - Posner-Schlossman syndrome, also known as **glaucomatocyclitic crisis**, is characterized by recurrent, acute attacks of **unilateral elevated intraocular pressure** (glaucomatous changes). - These attacks are accompanied by **mild anterior uveitis**, which typically presents with few or no precipitates and minimal redness. *Ipsilateral optic atrophy with contralateral papilloedema* - This constellation of symptoms, known as **Foster Kennedy syndrome**, is associated with intracranial masses, not Posner-Schlossman syndrome. - It involves **optic atrophy** in one eye due to direct pressure on the optic nerve and **papilledema** in the other eye due to increased intracranial pressure. *Granulomatous uveitis with iris heterochromia* - **Granulomatous uveitis** is characterized by large mutton-fat keratic precipitates and often seen in diseases like sarcoidosis or tuberculosis, which is not typical for Posner-Schlossman. - **Iris heterochromia** (different colored irises) is a characteristic feature of **Fuchs' heterochromic cyclitis**, another form of chronic anterior uveitis, but not Posner-Schlossman syndrome. *None of the options* - This option is incorrect as one of the provided choices accurately describes the characteristic features of Posner-Schlossman syndrome. - The other options describe different ophthalmological conditions.
Question 1016: What is the first-line treatment for acute angle closure glaucoma?
- A. Pilocarpine
- B. Beta blocker eyedrops
- C. IV mannitol
- D. Acetazolamide (Correct Answer)
Explanation: **Acetazolamide** - **Acetazolamide** (oral or intravenous) is a carbonic anhydrase inhibitor that rapidly reduces intraocular pressure by decreasing aqueous humor production, making it the **first-line medical treatment** for acute angle-closure glaucoma. - While other agents are used, acetazolamide provides the quickest and most significant initial reduction in **intraocular pressure (IOP)**, which is crucial in preventing permanent vision loss. *IV mannitol* - **Intravenous mannitol** is an osmotic diuretic used to draw fluid from the vitreous humor to lower **IOP** significantly, but it is typically reserved for cases where **acetazolamide** alone is insufficient or for very high **IOPs**. - It is often considered a second-line or adjunctive agent rather than the initial first-line treatment. *Pilocarpine* - **Pilocarpine** is a miotic agent that constricts the pupil, which helps to pull the iris away from the trabecular meshwork and open the angle. - However, it should only be administered *after* the **intraocular pressure** has been significantly lowered (e.g., with acetazolamide), as it can worsen angle closure in an inflamed eye with very high **IOP**. *Beta blocker eyedrops* - **Topical beta-blockers** (e.g., timolol) reduce **IOP** by decreasing aqueous humor production and are a common treatment for various types of glaucoma. - While useful in acute angle-closure glaucoma, they act more slowly than **acetazolamide** and are typically used as an adjunct rather than the sole initial first-line treatment.
Pharmacology
1 questionsWhich of the following antiglaucoma medications can cause drowsiness?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 1011: Which of the following antiglaucoma medications can cause drowsiness?
- A. Brimonidine (Correct Answer)
- B. Latanoprost
- C. Dorzolamide
- D. Timolol
Explanation: ***Brimonidine*** - **Brimonidine** is an **alpha-2 adrenergic agonist** [1] that can cause central nervous system depression, leading to side effects such as **drowsiness** and fatigue. - This systemic side effect is more common with the topical ophthalmic formulation due to systemic absorption. *Latanoprost* - **Latanoprost** is a **prostaglandin analog** that primarily works by increasing uveoscleral outflow, and its side effects are mainly localized to the eye (e.g., iris color change, eyelash growth). - It does not typically cause systemic side effects like drowsiness because its systemic absorption is minimal. *Dorzolamide* - **Dorzolamide** is a **topical carbonic anhydrase inhibitor** [1] that reduces aqueous humor production, and its most common side effects include local ocular irritation and a bitter taste. - While systemic carbonic anhydrase inhibitors can cause fatigue and drowsiness, the topical formulation has very limited systemic absorption, making drowsiness uncommon. *Timolol* - **Timolol** is a **non-selective beta-blocker** [1] that reduces aqueous humor production and can cause systemic side effects such as bradycardia, bronchospasm, and hypotension. - While some beta-blockers can cause fatigue, **drowsiness** as a prominent side effect is less common compared to alpha-2 agonists.
Surgery
2 questionsCommonest site of carcinoma tongue -
Which of the following conditions is not typically treated with a simple mastectomy?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 1011: Commonest site of carcinoma tongue -
- A. Apical
- B. Lateral borders (Correct Answer)
- C. Dorsum
- D. Posterior 1/3
Explanation: ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.
Question 1012: Which of the following conditions is not typically treated with a simple mastectomy?
- A. Paget's disease
- B. Fibroadenoma (Correct Answer)
- C. Cystosarcoma phyllodes
- D. None of the options
Explanation: ***Fibroadenoma*** - A **fibroadenoma** is a **benign tumor** of the breast that typically does not require a mastectomy for treatment. - Treatment usually involves **observation**, **excision**, or **cryoablation**, depending on size, symptoms, and patient preference. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that affects the nipple and areola, and is typically associated with an underlying **ductal carcinoma in situ** (DCIS) or **invasive breast cancer**. - Due to the presence of malignancy and its superficial spread, **mastectomy** (simple or modified radical) is often the recommended treatment, especially for extensive disease. *Cystosarcoma phyllodes* - Formerly known as **phyllodes tumor**, this is a rare **stromal tumor** of the breast that can be benign, borderline, or malignant. - Due to its potential for local recurrence and, in malignant cases, metastasis, **wide local excision with clear margins** is crucial, and a **simple mastectomy** may be necessary for large or recurrent tumors to achieve adequate margin control. *None of the options* - This option is incorrect because fibroadenoma is a condition not typically treated with a simple mastectomy, unlike Paget's disease and cystosarcoma phyllodes.