ENT
2 questionsWhat is the characteristic feature of ethmoidal polyps?
All are major symptoms of sinusitis except?
NEET-PG 2013 - ENT NEET-PG Practice Questions and MCQs
Question 1121: What is the characteristic feature of ethmoidal polyps?
- A. Usually multiple
- B. Typically recurrent (Correct Answer)
- C. Can occur in children
- D. Can be associated with infections
Explanation: ***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.
Question 1122: All are major symptoms of sinusitis except?
- A. Nasal blockage
- B. Facial congestion
- C. Halitosis (Correct Answer)
- D. Anosmia
Explanation: ***Halitosis*** - While **halitosis** (bad breath) can be a symptom associated with sinusitis due to post-nasal drip and bacterial overgrowth, it is generally considered a **minor symptom** or a secondary effect rather than one of the primary, defining features. - Major symptoms focus on those directly caused by inflammation and obstruction of the sinuses. *Nasal blockage* - **Nasal blockage** or congestion is a cardinal symptom of sinusitis, resulting from inflammation and swelling of the nasal and sinus mucosa. - It often leads to difficulty breathing through the nose and contributes to a feeling of fullness. *Facial congestion* - **Facial congestion** or pressure is a key symptom of sinusitis, caused by the buildup of fluid and inflammation within the sinus cavities. - This symptom can manifest as pain or pressure around the eyes, cheeks, and forehead. *Anosmia* - **Anosmia**, or the loss of smell, is a significant symptom of sinusitis, particularly chronic sinusitis. - It occurs due to the inflammation and obstruction of the nasal passages, preventing odorants from reaching the olfactory receptors.
Internal Medicine
1 questionsMost common sinus to be involved in acute sinusitis?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1121: Most common sinus to be involved in acute sinusitis?
- A. Ethmoid
- B. Maxillary (Correct Answer)
- C. Sphenoid
- D. Frontal
Explanation: ***Maxillary*** - The **maxillary sinuses** are the largest paranasal sinuses and are the most commonly involved in acute sinusitis due to their anatomical position and drainage characteristics. - Their ostia (drainage openings) are located on the superior aspect of the sinus, which can make drainage difficult when the patient is upright, leading to stasis of secretions and increased susceptibility to infection. *Ethmoid* - The ethmoid sinuses are a group of small air cells located between the eyes and are the second most commonly infected in sinusitis. - While frequently involved, especially in children, they are not as commonly affected as the maxillary sinuses in the general adult population with acute sinusitis. *Sphenoid* - The sphenoid sinuses are located deep within the skull, behind the eyes, and are the least commonly involved in acute sinusitis. - Inflammation here can be serious due to proximity to important structures like the optic nerves and carotid arteries, but it's not the most frequent site of infection. *Frontal* - The frontal sinuses are located in the forehead and are less commonly involved in acute sinusitis compared to the maxillary and ethmoid sinuses. - Their development is not complete until adolescence, and they are typically drained via the frontonasal duct, which can become easily obstructed.
Microbiology
2 questionsWhat is the most common cause of a peritonsillar abscess?
What is the most common cause of acute tonsillitis?
NEET-PG 2013 - Microbiology NEET-PG Practice Questions and MCQs
Question 1121: What is the most common cause of a peritonsillar abscess?
- A. Streptococcus pneumoniae
- B. Staphylococcus aureus
- C. H. influenzae
- D. Group A beta-hemolytic streptococcus (Correct Answer)
Explanation: ***Group A beta-hemolytic streptococcus*** - This bacterium, also known as **_Streptococcus pyogenes_**, is the most common cause of **streptococcal pharyngitis**, which is the precursor to most peritonsillar abscesses. - Peritonsillar abscesses are typically a complication of untreated or inadequately treated **tonsillitis**. *Streptococcus pneumoniae* - While **_Streptococcus pneumoniae_** can cause upper respiratory infections like sinusitis and otitis media, it is not the primary cause of peritonsillar abscesses. - Its infections are more commonly associated with **pneumonia** and **meningitis**. *Staphylococcus aureus* - **_Staphylococcus aureus_** is a common cause of skin and soft tissue infections, but it is less frequently isolated as the primary pathogen in peritonsillar abscesses. - It can be involved in **polymicrobial infections** or as a secondary invader. *H. influenzae* - **_Haemophilus influenzae_** can cause various infections, particularly in children, such as otitis media and epiglottitis. - However, it is not considered the most common cause of **peritonsillar abscesses**.
Question 1122: What is the most common cause of acute tonsillitis?
- A. Streptococcus pneumoniae
- B. H. influenzae
- C. Staphylococcus aureus
- D. Group A beta-hemolytic streptococci (Correct Answer)
Explanation: ***Group A beta-hemolytic streptococci*** - **Group A Streptococcus (GAS)**, specifically *Streptococcus pyogenes*, is the most frequent bacterial cause of **acute tonsillitis** and pharyngitis, especially in school-aged children. - Infection can lead to complications such as **rheumatic fever** and **post-streptococcal glomerulonephritis** if not appropriately treated. *Streptococcus pneumoniae* - While *S. pneumoniae* is a common cause of **otitis media**, **sinusitis**, and **pneumonia**, it is less commonly the primary cause of acute tonsillitis. - It typically causes respiratory infections involving the lower airways or adjacent structures rather than primarily tonsillar inflammation. *H. Influenza* - *Haemophilus influenzae* is a significant pathogen for **otitis media**, **epiglottitis**, and **meningitis**, particularly in unvaccinated children. - It is not a common primary cause of acute tonsillitis, which is predominantly bacterial or viral. *Staphylococcus aureus* - *Staphylococcus aureus* is often associated with **skin and soft tissue infections**, as well as more serious conditions like **sepsis** and **endocarditis**. - Although it can cause pharyngeal infections, it is an infrequent cause of acute tonsillitis compared to Group A Streptococcus.
Radiology
3 questionsTear drop sign is seen in?
What is the investigation of choice for nasopharyngeal angiofibroma?
Which CT view is best for visualizing paranasal polyps?
NEET-PG 2013 - Radiology NEET-PG Practice Questions and MCQs
Question 1121: Tear drop sign is seen in?
- A. Fracture zygomatic arch
- B. Fracture maxilla
- C. Fracture mandible
- D. Blow out fracture (Correct Answer)
Explanation: ***Blow out fracture*** - The **tear drop sign** on imaging (often CT scan) is characteristic of an **orbital blow-out fracture**, indicating herniation of orbital contents (fat, muscle) into the maxillary sinus. - This fracture typically involves the **orbital floor** or medial wall, often caused by a blunt force trauma to the eye. *Fracture zygomatic arch* - A fracture of the zygomatic arch is often associated with a **flattening of the malar prominence** rather than a "tear drop" sign. - It might lead to restricted jaw movement if the arch impinges on the coronoid process. *Fracture maxilla* - Maxillary fractures (e.g., Le Fort fractures) involve the midface bones and cause **facial deformity**, malocclusion, and mobility of the maxilla. - The tear drop sign is not a primary diagnostic feature of maxillary fractures. *Fracture mandible* - Mandibular fractures present with pain, swelling, and **malocclusion** of the teeth. - Imaging would reveal a break in the mandible, not a tear drop sign associated with orbital contents.
Question 1122: What is the investigation of choice for nasopharyngeal angiofibroma?
- A. Contrast-enhanced CT (Correct Answer)
- B. Plain CT
- C. X-ray
- D. MRI
Explanation: ***Contrast-enhanced CT*** - A **contrast-enhanced CT** scan is the investigation of choice for **nasopharyngeal angiofibroma** due to its ability to clearly delineate the extent of the tumor, its vascularity, and its bony involvement. - The contrast highlights the **highly vascular nature** of the angiofibroma, which is crucial for surgical planning and embolization. *X-ray* - **X-rays** provide limited detail of soft tissue structures and mass lesions in the complex anatomy of the nasopharynx. - They are generally not sensitive enough to characterize a tumor like **angiofibroma** or determine its exact extent. *Plain CT* - A **plain CT** (non-contrast CT) can show soft tissue masses and bony erosion but lacks the ability to assess the **vascularity** of the tumor. - Without contrast, it's difficult to differentiate the tumor from surrounding tissues or identify its blood supply, which is critical for **angiofibroma** management. *MRI* - While **MRI** offers excellent soft tissue contrast and is valuable for assessing intracranial extension or perineural spread, **contrast-enhanced CT** is generally preferred as the primary imaging modality for angiofibroma. - **CT with contrast** is superior for demonstrating **bony erosion** and the characteristic **vascularity** of this tumor.
Question 1123: Which CT view is best for visualizing paranasal polyps?
- A. Coronal view (Correct Answer)
- B. Axial view
- C. Sagittal view
- D. 3D view
Explanation: ***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.
Surgery
2 questionsWhich fracture pattern is classified as a Le Fort I fracture?
What imaging study is typically required before endoscopic sinus surgery?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 1121: Which fracture pattern is classified as a Le Fort I fracture?
- A. Pyramidal fracture involving maxilla and nasal bones
- B. Complete craniofacial separation involving the upper face
- C. Isolated nasal bone fracture
- D. Horizontal fracture of the maxilla separating teeth from upper jaw (Correct Answer)
Explanation: **Horizontal fracture of the maxilla separating teeth from upper jaw** - A **Le Fort I fracture** is a **horizontal fracture** that detaches the entire **maxillary arch**, including the **palate** and **alveolar process**, from the rest of the facial skeleton. - This fracture line typically extends **above the level of the nasal floor** and involves the **pterygoid plates**. *Pyramidal fracture involving maxilla and nasal bones* - This description corresponds to a **Le Fort II fracture**, which is a **pyramidal fracture** involving the **nasal bones**, **medial walls of the orbits**, and the **maxilla**. - It creates a central fragment that includes the **nasal bridge** and part of the maxilla, separating it from the frontal bone. *Complete craniofacial separation involving the upper face* - This refers to a **Le Fort III fracture**, also known as **craniofacial disjunction**. - It involves the separation of the entire **midfacial skeleton** from the **cranial base**, often extending through the **zygomaticofrontal sutures** and **nasofrontal sutures**. *Isolated nasal bone fracture* - An **isolated nasal bone fracture** involves only the nasal bones and does not extend into the maxilla or other facial structures. - It is a much more **localized injury** compared to any of the Le Fort fracture patterns.
Question 1122: What imaging study is typically required before endoscopic sinus surgery?
- A. MRI of paranasal sinus
- B. CT of PNS (Correct Answer)
- C. Acoustic tests
- D. Mucociliary clearing testing
Explanation: ***CT of PNS*** - A **CT scan of the paranasal sinuses** is crucial prior to endoscopic sinus surgery for detailed anatomical mapping. - It helps identify **key anatomical landmarks**, variations, and the extent of disease, minimizing surgical risks. *MRI of paranasal sinus* - **MRI** is generally reserved for evaluating **soft tissue abnormalities**, such as tumors, fungal infections, or intracranial extension. - It provides less detail regarding **bony anatomy** and is not the primary imaging modality for surgical planning in routine cases. *Mucociliary clearing testing* - **Mucociliary clearing tests** assess the function of the **mucociliary escalator** in the nasal cavity and sinuses. - These tests are primarily diagnostic for conditions like **primary ciliary dyskinesia** and do not provide anatomical detail for surgical guidance. *Acoustic tests* - **Acoustic tests** are typically used to assess **hearing function** in the ear. - They have **no relevance** to the anatomical evaluation of the paranasal sinuses or planning for endoscopic sinus surgery.