NEET-PG 2013 Practice Questions

Q: Panophthalmitis involves ?

All structures of the eyeball including Tenon's capsule. ***All structures of the eyeball including Tenon's capsule*** - **Panophthalmitis** is a severe inflammation or infection that affects **all coats of the eyeball** (sclera, choroid, retina). - Crucially, it also extends to the **intraocular contents** and the **Tenon's capsule**, leading to potential destruction of the entire eye. *Inner coat of eyeball* - This description is characteristic of **uveitis** (inflammation of the uvea: iris, ciliary body, choroid) or **endophthalmitis** if it extends to the vitreous and retina. - However, **panophthalmitis** is a more extensive condition, involving more than just the inner coats. *Inner and outer coat but sparing tenon's capsule* - This scenario describes **endophthalmitis**, which involves inflammation of the internal structures of the eye (vitreous, retina, choroid) and potentially the sclera. - However, the sparing of Tenon's capsule differentiates it from **panophthalmitis**, which expressly includes involvement of this fibrous sheath. *None of the options* - This option is incorrect because Option C accurately describes the comprehensive nature of **panophthalmitis**, which is an inflammation of all ocular structures, including Tenon's capsule. - The definition of panophthalmitis is critical in distinguishing it from less severe inflammatory conditions of the eye.

Q: In photophthalmia, which part of the eye is primarily affected?

Cornea. ***Cornea*** - **Photophthalmia** (also known as **snow blindness** or **arc eye**) is caused by overexposure to **ultraviolet (UV) light**, which primarily damages the **corneal epithelium**. - This damage leads to **superficial punctate keratitis**, characterized by pain, foreign body sensation, photophobia, and blurred vision. - Symptoms typically appear **6-12 hours after exposure** and resolve within **24-48 hours** with supportive care. *Retina* - The **retina** can be damaged by certain types of light (e.g., solar retinopathy from looking at the sun), but **UV light** in photophthalmia is largely absorbed by the anterior structures of the eye, particularly the cornea. - Retinal damage would typically present with **central visual loss** or **scotomas**, differing from the acute pain and photophobia of photophthalmia. *Optic nerve* - The **optic nerve** transmits visual information from the retina to the brain and is generally not directly affected by **UV light exposure** causing photophthalmia. - Optic nerve issues would manifest as severe **vision loss**, **pupillary abnormalities**, or **pain with eye movement**, which are not typical for photophthalmia. *Lens* - While chronic **UV exposure** can contribute to **cataract formation** in the lens over time, this is a long-term effect, not the acute primary damage seen in photophthalmia. - The acute presentation of photophthalmia with severe pain, photophobia, and foreign body sensation is characteristic of **corneal epithelial damage**, not lens involvement.

Q: Ameboid ulcers are primarily associated with which type of corneal ulcer?

Acanthamoeba corneal ulcer. ***Acanthamoeba corneal ulcer*** - **Acanthamoeba** infections are classically associated with **ameboid ulcers** due to the movement and destructive nature of this protozoan. - This type of ulcer often presents with severe pain, disproportionate to clinical findings, and can have a **ring infiltrates** appearance. *Fungal corneal ulcer* - Fungal ulcers typically present with a **feathery border** and satellite lesions, not ameboid shapes. - They are often associated with a history of **ocular trauma** involving plant material. *Herpetic corneal ulcer* - Herpetic ulcers are characterized by a **dendritic pattern** (tree-branch-like), which is distinct from an ameboid shape. - They are caused by the **herpes simplex virus** and can lead to recurrent episodes. *Bacterial corneal ulcer* - Bacterial ulcers typically present as a **round or oval infiltrate** with stromal edema and an overlying epithelial defect. - They can progress rapidly and are not described as having an **ameboid configuration**.

Q: The most common translocation seen in patients with Multiple Myeloma is:

t(11;14). ***t(11;14)*** - This translocation is the **most common cytogenetic abnormality** found in patients with multiple myeloma, occurring in approximately 15-20% of cases. - It results in the juxtaposition of the **IgH gene on chromosome 14** with the **cyclin D1 gene on chromosome 11**, leading to overexpression of cyclin D1. *t(4;14)* - This translocation, occurring in about 5-10% of patients, is associated with a **poor prognosis** in multiple myeloma. - It involves the IgH gene on chromosome 14 and the **FGFR3 and MMSET genes on chromosome 4**, leading to their upregulation. *t(14;16)* - This translocation is also associated with a **poor prognosis** and is less common than t(11;14) or t(4;14), found in about 2-5% of cases. - It involves the **IgH gene on chromosome 14** and the **c-MAF gene on chromosome 16**, leading to overexpression of c-MAF. *t(14;20)* - This translocation is **rarely observed** in multiple myeloma patients, typically occurring in less than 1% of cases. - It involves the **IgH gene on chromosome 14** and the **MAFB gene on chromosome 20**, which can also contribute to disease progression.

Q: What is the most appropriate method for administering asthma treatment to an infant under one year of age?

MDI with Spacer and Mask. ***MDI with Spacer and Mask*** - For infants and young children, a **metered-dose inhaler (MDI)** used with a **spacer** and a **well-fitting mask** is the **most appropriate** method for delivering asthma medication. - The spacer helps to reduce the velocity of the aerosol and allows the infant to inhale the medication over several breaths, while the mask ensures the medication is delivered to the airways without significant loss. - This method is **portable**, **convenient**, and **cost-effective** for routine outpatient management. *MDI with Spacer (no mask)* - While a spacer is crucial for optimizing drug delivery from an MDI, an infant cannot effectively seal their lips around a spacer mouthpiece for proper inhalation. - This method would result in significant **medication loss** and insufficient dose delivery to the lungs. *MDI with Mask (no spacer)* - An MDI used directly with a mask without a spacer leads to inefficient drug delivery due to the **high velocity** of the aerosol spray. - The medication impinges on the back of the throat and face, reducing the amount that reaches the small airways. *Nebulizer therapy* - Nebulizers are also an **acceptable and effective option** for infants, particularly in acute settings or when families find them easier to use. - However, they are **time-consuming** (typically 10-15 minutes per treatment), require a power source or batteries, and are less portable than MDI systems. - For **routine outpatient management**, an MDI with spacer and mask is generally **preferred** due to its convenience, portability, and comparable efficacy when used correctly.

Q: The procedure of choice for the evaluation of aortic aneurysms is -

Computed tomography. ***Computed tomography*** - **Computed tomography (CT)** offers excellent spatial resolution and is the gold standard for diagnosing, staging, and pre-operative planning for aortic aneurysms. - It precisely measures aneurysm size, detects mural thrombus, assesses rupture risk, and evaluates the extent of involvement with surrounding structures. *Ultrasonography* - While useful for initial screening and serial monitoring of known abdominal aortic aneurysms due to its non-invasiveness and cost-effectiveness, its accuracy can be limited by **patient body habitus** and **bowel gas**. - It may not reliably visualize the entire aorta or accurately assess complex anatomy and rupture. *Magnetic resonance imaging* - **Magnetic resonance imaging (MRI)** provides detailed anatomical information and avoids radiation exposure, but it is typically more expensive and time-consuming than CT. - It is often reserved for patients with **renal insufficiency** where iodinated contrast is a concern or when evaluating specific tissue characteristics not well seen on CT. *Arteriography* - **Arteriography** (angiography) is an invasive procedure involving direct contrast injection, carrying risks such as arterial injury and nephrotoxicity. - While it can visualize the aortic lumen, it primarily shows the patent lumen and may **underestimate the true aneurysm size** due to mural thrombus. It is typically used for intervention planning or specific contexts rather than initial diagnosis.

Q: What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

Thiersch's operation. ***Thiersch's operation*** - **Thiersch's operation** is a perineal procedure involving the placement of a **circum-anal cerclage** (a non-absorbable suture) around the anal canal to prevent external prolapse. - It is preferred in elderly or frail patients due to its **minimal invasiveness**, low operative risk, and suitability for local or regional anesthesia as a palliative measure for symptoms. *Delorme's procedure* - **Delorme's procedure** is a perineal approach that involves the **mucosal stripping** of the prolapsed rectum, plication of the muscularis, and re-anastomosis. - While less invasive than abdominal approaches, it is more complex than Thiersch's and may still carry higher operative risks for very frail patients. *Wells' procedure* - **Wells' procedure** (rectopexy via an abdominal approach) involves **mobilization of the rectum** and its fixation to the sacrum, often with a mesh. - This is a more invasive abdominal procedure with a higher operative risk, making it unsuitable for elderly patients unfit for major surgery. *Low anterior resection* - **Low anterior resection** is a major abdominal procedure primarily used for rectal cancer or severe inflammatory bowel disease, involving the **surgical removal of a segment of the rectum**. - It is a highly invasive procedure with significant morbidity and mortality, making it inappropriate for the palliative management of rectal prolapse in frail elderly patients.

Q: Which of the following is a component of the Alvarado score?

Loss of appetite. ***Loss of appetite*** - **Anorexia** (loss of appetite) is a key symptom considered in the Alvarado score, contributing 1 point to the total. - This symptom is often one of the **earliest indicators** of acute appendicitis. *Leucopenia* - The Alvarado score uses **leukocytosis** (elevated white blood cell count greater than 10,000/mm³), not leucopenia, as a component. - **Leucopenia** (decreased white blood cell count) is generally not indicative of acute appendicitis. *Diarrhea* - While diarrhea can sometimes accompany appendicitis, it is **not a specific component** of the Alvarado score. - The score focuses on classic appendicitis symptoms like **migratory and right lower quadrant pain**. *Periumbilical pain* - The Alvarado score specifically considers **migratory pain to the right iliac fossa** (RLQ tenderness) as a component, not just periumbilical pain. - Although pain often starts periumbilically, the score emphasizes the **subsequent migration** of pain.

Q: Which of the following conditions is not typically treated with a simple mastectomy?

Fibroadenoma. ***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.

Question 1

Panophthalmitis involves ?

Accepted Answer

All structures of the eyeball including Tenon's capsule

Answer

Inner coat of eyeball

Answer

Inner and outer coat but sparing tenon's capsule

Answer

None of the options

Question 2

In photophthalmia, which part of the eye is primarily affected?

Accepted Answer

Cornea

Answer

Lens

Answer

Retina

Answer

Optic nerve

Question 3

Dacryocystorhinostomy involves?

Accepted Answer

Connecting the lacrimal sac to the nose by opening the medial wall

Answer

Opening the terminal blocked end of the nasolacrimal duct

Answer

Complete excision of the lacrimal sac

Answer

Insertion of a drainage tube in the lacrimal sac

Question 4

Ameboid ulcers are primarily associated with which type of corneal ulcer?

Accepted Answer

Acanthamoeba corneal ulcer

Answer

Fungal corneal ulcer

Answer

Bacterial corneal ulcer

Answer

Herpetic corneal ulcer

Question 5

The most common translocation seen in patients with Multiple Myeloma is:

Accepted Answer

t(11;14)

Answer

t(14;16)

Answer

t(4;14)

Answer

t(14;20)

Question 6

What is the most appropriate method for administering asthma treatment to an infant under one year of age?

Accepted Answer

MDI with Spacer and Mask

Answer

MDI with Mask (no spacer)

Answer

Nebulizer therapy

Answer

MDI with Spacer (no mask)

Question 7

The procedure of choice for the evaluation of aortic aneurysms is -

Accepted Answer

Computed tomography

Answer

Magnetic resonance imaging

Answer

Arteriography

Answer

Ultrasonography

Question 8

What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

Accepted Answer

Thiersch's operation

Answer

Delorme's procedure

Answer

Wells' procedure

Answer

Low anterior resection

Question 9

Which of the following is a component of the Alvarado score?

Accepted Answer

Loss of appetite

Answer

Leucopenia

Answer

Diarrhea

Answer

Periumbilical pain

Question 10

Which of the following conditions is not typically treated with a simple mastectomy?

Accepted Answer

Fibroadenoma

Answer

Paget's disease

Answer

Cystosarcoma phyllodes

Answer

None of the options

NEET-PG 2013

Ophthalmology

Pathology

Pediatrics

Radiology

Surgery