NEET-PG 2013 Practice Questions

Q: Through which meatus is a nasal puncture typically performed?

Inferior meatus. ---Inferior meatus--- - A nasal puncture for **maxillary sinus irrigation** is typically performed through the **inferior meatus** because it provides direct access to the floor of the nasal cavity and the passage to the maxillary sinus. - The floor of the **inferior meatus** is the thinnest part of the lateral nasal wall, making it an ideal entry point for procedures into the maxillary sinus. *Superior meatus* - The **superior meatus** is associated with the drainage of the **posterior ethmoid cells** and the **sphenoid sinus**. - Puncturing here would not provide access for maxillary sinus irrigation and could risk damage to the **cribriform plate**. *Middle meatus* - The **middle meatus** is where the **maxillary**, **frontal**, and **anterior ethmoid sinuses** primarily drain. - While related to the maxillary sinus, it is not the preferred site for a puncture for irrigation, as it is more complex and less direct than the inferior meatus. *Sphenoethmoidal recess* - The **sphenoethmoidal recess** is located superior to the superior concha and is the drainage site for the **sphenoid sinus**. - This area is too high and posterior to be relevant for a puncture aimed at the **maxillary sinus**.

Q: All are absolute indications of tonsillectomy except which of the following?

Chronic tonsillitis. ***Chronic tonsillitis*** - **Chronic tonsillitis** is a **relative indication** for tonsillectomy, not an **absolute indication**. - It becomes an indication based on frequency criteria (e.g., Paradise criteria: ≥7 episodes in 1 year, ≥5 episodes per year for 2 years, or ≥3 episodes per year for 3 years). - Absolute indications involve conditions requiring urgent surgical intervention. *Suspicious malignancy* - Suspected **malignancy** is an **absolute indication** for tonsillectomy to obtain tissue for histopathological diagnosis. - Early diagnosis and treatment of tonsillar malignancy is critical for patient outcomes. *Peritonsillar abscess* - **Peritonsillar abscess** (quinsy) is typically managed with needle aspiration or incision & drainage plus antibiotics, NOT immediate tonsillectomy. - Acute tonsillectomy during active infection ("hot tonsillectomy") is generally **contraindicated** due to increased bleeding risk and surgical complications. - **Recurrent peritonsillar abscess** may warrant **interval tonsillectomy** (4-6 weeks after resolution) as a **relative indication**, not an absolute one. *Tonsils causing obstructive sleep apnea* - **Obstructive sleep apnea (OSA)** caused by tonsillar hypertrophy is an **absolute indication** for tonsillectomy, particularly in children. - Untreated OSA can lead to serious complications including failure to thrive, cor pulmonale, developmental delays, and neurocognitive problems.

Q: Early tonsillectomy is not done in?

Thyroid storm. ***Thyroid storm*** - **Thyroid storm** is a life-threatening medical emergency caused by exaggerated hyperthyroidism, requiring immediate medical stabilization to control hormone levels and systemic effects. - Early tonsillectomy is **contraindicated** in this scenario because it would add significant surgical stress and anesthetic risks to an already critically unstable patient. *Peritonsillar abscess* - A **quinsy tonsillectomy** (abscess tonsillectomy) is often performed acutely, especially if drainage is difficult or if it's the first episode, to resolve the abscess and remove the infected tissue. - This procedure can be done in the acute phase of a peritonsillar abscess to relieve symptoms and reduce the risk of recurrence. *Rheumatic fever* - Patients with recurrent **acute tonsillitis** who are at risk of developing **rheumatic fever** are strong candidates for tonsillectomy to prevent further streptococcal infections and subsequent autoimmune complications. - Tonsillectomy is considered a prophylactic intervention in cases of recurrent strep throat leading to rheumatic fever. *Suspected malignancy* - If tonsillar asymmetry or other signs raise suspicion of **tonsillar malignancy**, prompt tonsillectomy is often performed for **diagnostic biopsy** and initial tumor removal. - Early surgical intervention is crucial for diagnosing and staging potential tonsil cancer, which can guide subsequent treatment.

Q: Which objective test is most effective for examining adenoids?

Posterior rhinoscopy. ***Posterior rhinoscopy*** - This method allows for **direct visualization of the nasopharynx** where the adenoids are located, using a post-nasal mirror or flexible endoscope. - It provides an **objective assessment** of adenoid size, extent, and any associated obstruction by direct observation. - Among the clinical examination methods listed, this is the most effective for **visualizing adenoid tissue** and assessing hypertrophy. - In modern practice, flexible nasopharyngoscopy has largely replaced mirror examination, but posterior rhinoscopy remains the principle of direct nasopharyngeal visualization. *Anterior rhinoscopy* - This technique examines the **anterior nasal cavity**, nasal septum, and inferior turbinates. - It **cannot visualize the nasopharynx** where adenoids are located due to anatomical limitations. - Useful for anterior nasal pathology but inadequate for adenoid assessment. *Manual palpation* - This is a **subjective, not objective** method that relies on examiner's tactile sensation. - Highly uncomfortable for children, causing gagging and distress. - Carries risks of trauma, bleeding, and infection. - Does not provide measurable or reproducible data, hence not considered an objective test. - Largely abandoned in modern practice due to these limitations. *None of the options* - Incorrect because **posterior rhinoscopy is a recognized objective clinical examination** for adenoids. - It allows direct visualization which can be documented and is superior to subjective methods like palpation. - While radiological methods (lateral neck X-ray) also provide objective data, among the examination techniques listed, posterior rhinoscopy is the correct answer.

Q: Mucoperichondrial flap in septoplasty is made on?

Septal cartilage. ***Septal cartilage*** - A mucoperichondrial flap is meticulously raised on the **septal cartilage** during septoplasty to access and correct deviations of the nasal septum. - This flap preserves the **perichondrium** and overlying mucosa, which is crucial for nutrient supply and healing of the septal cartilage. *Alar cartilage* - The alar cartilage forms the **lower lateral aspect** of the nose and is not involved in creating a mucoperichondrial flap for septal correction. - Procedures involving alar cartilage typically address **nasal tip projection** or alar rim deformities. *Maxillary spine* - The maxillary spine is a **bony prominence** at the anterior nasal floor and forms part of the underlying support for the septum. - While it can sometimes be a site of septal deviation, a mucoperichondrial flap is not primarily raised over the maxillary spine itself. *Sphenoid spine* - The sphenoid spine is a **bony projection** found on the sphenoid bone, located deep within the cranial base, posterior to the nasal cavity. - It is anatomically distant from the nasal septum and has no role in septoplasty or mucoperichondrial flap creation for septal surgical access.

Q: Rosen's incision is used for which surgical procedure?

Stapedectomy. ***Stapedectomy*** - **Rosen's incision** is a **curved incision in the posterior ear canal** specifically used for **stapedectomy** surgery. - This incision provides excellent exposure of the **middle ear** and particularly the **stapes footplate** for otosclerosis surgery. - The incision extends from approximately **6 o'clock to 12 o'clock** position in the posterior canal, allowing the tympanomeatal flap to be elevated. *Tympanoplasty* - **Tympanoplasty** (repair of perforated tympanic membrane) can use various incisions including **permeatal**, **endaural**, or **postauricular** approaches. - While transmeatal approaches are used, they are not specifically termed "Rosen's incision," which is reserved for stapes surgery. *Septoplasty* - **Septoplasty** is a nasal procedure for correcting a deviated septum using incisions like **hemitransfixion** or **Killian's incision**. - This procedure involves the **nasal septum**, not the ear canal. *Tonsillectomy* - **Tonsillectomy** is performed entirely through an **oral approach** for removal of palatine tonsils. - No external or ear canal incisions are involved.

Q: Which of the following is a common finding in patients with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Normal BP. ***Normal BP*** - In SIADH, patients are typically **euvolemic** due to the primary issue being water retention rather than salt retention or frank dehydration [2]. - While hyponatremia occurs, the body's compensatory mechanisms usually prevent significant changes in blood pressure, maintaining it within the **normal range**. *Generalized edema* - Generalized edema is uncommon in SIADH because the excessive water retention is initially within the **intravascular compartment**, and the body attempts to excrete the additional volume of water [1]. - Although the patient is effectively retaining water, the osmolality is low, leading to fluid shifts rather than overt edema unless severe, protracted fluid overload occurs. *Ascites* - **Ascites**, which is the accumulation of fluid in the peritoneal cavity, is not a characteristic feature of SIADH [2]. - Ascites is more commonly associated with conditions like **liver cirrhosis**, heart failure, or malignancy. *Dry mucous membrane* - **Dry mucous membranes** are a sign of dehydration and fluid volume deficit. - In contrast, SIADH involves **fluid overload** (though euvolemic), making dry mucous membranes an unlikely finding [2].

Q: A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?

Ketoconazole. ***Ketoconazole*** - **Ketoconazole** is an antifungal agent that also inhibits several enzymes involved in **steroidogenesis**, including 17α-hydroxylase and 11β-hydroxylase. - This action helps to reduce the overproduction of **cortisol** in Cushing syndrome caused by an adrenal tumor. *Hydrocortisone* - **Hydrocortisone** is a glucocorticoid itself and would exacerbate the symptoms of **Cushing syndrome** by adding to the already elevated cortisol levels. - It is used for **cortisol replacement therapy** in conditions like Addison's disease, where cortisol levels are low. *Dexamethasone* - **Dexamethasone** is a potent synthetic glucocorticoid used to suppress **ACTH production** in cases of ACTH-dependent Cushing's syndrome (e.g., Cushing's disease) or to diagnose Cushing's syndrome. - In an adrenal tumor, which is **ACTH-independent**, dexamethasone would not reduce cortisol production but could instead worsen the hypercortisolism. *Spironolactone* - **Spironolactone** is an **aldosterone antagonist** and a weak antiandrogen, primarily used for conditions like hyperaldosteronism, heart failure, and hirsutism. - It has no direct effect on the overproduction of **cortisol** from an adrenal tumor in Cushing syndrome.

Q: Which of the following is not typically associated with Treacher Collins syndrome?

Choanal atresia. Choanal atresia - While Treacher Collins syndrome involves various craniofacial anomalies, **choanal atresia** (blockage of the nasal airway) is **not a typical** or defining feature. - Choanal atresia is more commonly associated with conditions like **CHARGE syndrome** or isolated congenital defects. *Conductive deafness* - **Conductive deafness** is a common feature of Treacher Collins syndrome due to malformations of the **ossicles** and external ear structures. - The abnormal development of middle ear components prevents proper sound transmission, occurring in approximately **50% of cases**. *Cleft palate* - Although less frequent than other features, a **cleft palate** can occur in some individuals with Treacher Collins syndrome, especially in more severe cases. - It results from incomplete fusion of the palatal shelves during embryonic development, occurring in approximately **28-35% of cases**. *Mandibular hypoplasia* - **Mandibular hypoplasia** (underdevelopment of the jaw) is a **hallmark characteristic** of Treacher Collins syndrome, leading to a small chin and retrognathia. - This often contributes to feeding and breathing difficulties in affected individuals. *Malar hypoplasia* - **Malar hypoplasia** (underdevelopment of the cheekbones) is a **classic and defining feature** of Treacher Collins syndrome. - This results in flattened cheeks and contributes to the characteristic facial appearance of the condition.

Q: What is the best imaging view for assessing the nasal bone in X-ray?

Lateral. ***Lateral*** - The **lateral view** provides a clear profile of the nasal bones, allowing for the best assessment of fractures, displacement, and angulation. - It visualizes the nasal bone in relation to other facial structures, which is crucial for treatment planning. *Towne's* - The **Towne's view** is primarily used to visualize the **occipital bone** and the **foramen magnum**, not the nasal bones. - It projects the petrous pyramids inferiorly, which would obstruct the view of the nasal region. *Caldwell* - The **Caldwell view** is primarily used to assess the **frontal sinuses**, **ethmoid sinuses**, and **orbits**. - While it offers some visualization of the nasal region, it does not provide the detailed lateral projection needed for optimal nasal bone assessment. *Submentovertical* - The **submentovertical view** (also known as the **basal view**) is primarily used to visualize the **base of the skull**, **sphenoid sinuses**, and **zygomatic arches**. - This view does not offer a direct or clear projection of the nasal bones themselves.

Question 1

Through which meatus is a nasal puncture typically performed?

Accepted Answer

Inferior meatus

Answer

Superior meatus

Answer

Middle meatus

Answer

Sphenoethmoidal recess

Question 2

All are absolute indications of tonsillectomy except which of the following?

Accepted Answer

Chronic tonsillitis

Answer

Peritonsillar abscess

Answer

Tonsils causing obstructive sleep apnea

Answer

Suspicious malignancy

Question 3

Early tonsillectomy is not done in?

Accepted Answer

Thyroid storm

Answer

Peritonsillar abscess

Answer

Rheumatic fever

Answer

Suspected malignancy

Question 4

Which objective test is most effective for examining adenoids?

Accepted Answer

Posterior rhinoscopy

Answer

Anterior rhinoscopy

Answer

Manual palpation

Answer

None of the options

Question 5

Mucoperichondrial flap in septoplasty is made on?

Accepted Answer

Septal cartilage

Answer

Alar cartilage

Answer

Maxillary spine

Answer

Sphenoid spine

Question 6

Rosen's incision is used for which surgical procedure?

Accepted Answer

Stapedectomy

Answer

Septoplasty

Answer

Tonsillectomy

Answer

Tympanoplasty

Question 7

Which of the following is a common finding in patients with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Accepted Answer

Normal BP

Answer

Ascites

Answer

Generalized edema

Answer

Dry mucous membrane

Question 8

A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?

Accepted Answer

Ketoconazole

Answer

Spironolactone

Answer

Hydrocortisone

Answer

Dexamethasone

Question 9

Which of the following is not typically associated with Treacher Collins syndrome?

Accepted Answer

Choanal atresia

Answer

Conductive deafness

Answer

Cleft palate

Answer

Mandibular hypoplasia

Answer

Malar hypoplasia

Question 10

What is the best imaging view for assessing the nasal bone in X-ray?

Accepted Answer

Lateral

Answer

Towne's

Answer

Submentovertical

Answer

Caldwell

NEET-PG 2013

ENT

Internal Medicine

Pharmacology

Psychiatry

Radiology