NEET-PG 2024 Practice Questions

Q: Impaired gag reflex is seen due to a lesion in which cranial nerves?

CN IX & X. ***Correct: CN IX & X*** The **gag reflex (pharyngeal reflex)** is a protective reflex involving two cranial nerves: - **Afferent limb**: **CN IX (Glossopharyngeal nerve)** provides sensory innervation to the posterior third of the tongue, oropharynx, and pharyngeal walls - **Efferent limb**: **CN X (Vagus nerve)** provides motor innervation to the pharyngeal muscles (via the pharyngeal plexus) that contract during the reflex **Clinical correlation**: Testing the gag reflex helps assess brainstem function and the integrity of CN IX and X. Impairment suggests lesions affecting these nerves or their nuclei in the medulla. *Incorrect: CN V & VI* - CN V (Trigeminal) provides facial sensation and motor to muscles of mastication, not involved in gag reflex - CN VI (Abducens) controls lateral rectus muscle for eye abduction *Incorrect: CN X & XI* - While CN X is involved, CN XI (Accessory nerve) innervates sternocleidomastoid and trapezius muscles, not pharyngeal muscles *Incorrect: CN VII & VIII* - CN VII (Facial) controls facial expression and taste from anterior 2/3 of tongue - CN VIII (Vestibulocochlear) is involved in hearing and balance, not the gag reflex *Incorrect: CN XI & XII* - CN XI (Accessory) innervates SCM and trapezius - CN XII (Hypoglossal) provides motor to intrinsic and extrinsic tongue muscles, not pharyngeal muscles involved in gag reflex

Q: A nasal surgery was carried out with the incision shown in the image. What was the procedure likely carried out?

Open rhinoplasty. ***Open rhinoplasty*** - The image displays a **transcolumellar incision** (typically inverted V or W-shaped), which is the hallmark approach for **open rhinoplasty**. - This incision allows for direct visualization of the underlying nasal cartilages and bones, enabling precise reshaping of the nose. *Submucosal resection (SMR)* - SMR is a procedure to correct a **deviated nasal septum** by removing cartilage or bone from beneath the mucoperichondrial flaps. - It involves an **intranasal incision**, usually along the septal mucosa, not an external transcolumellar incision. *FESS (Functional Endoscopic Sinus Surgery)* - FESS is a minimally invasive procedure used to treat **chronic sinusitis** and other sinus conditions. - It is performed entirely **endoscopically through the nostrils**, with no external incisions on the nasal columella. *Caldwell-Luc's procedure* - This procedure accesses the **maxillary sinus** through an incision in the upper gum beneath the lip. - It is used for drainage of the maxillary sinus or removal of foreign bodies/tumors, and does not involve an external nasal incision.

Q: In a patient with right vestibular neuronitis, what will be the finding on the head impulse test?

Head turned to right, corrective saccade to the left. ***Head turned to right, corrective saccade to the left*** - In **right vestibular neuronitis**, the right vestibular apparatus is impaired, affecting the **vestibulo-ocular reflex (VOR)** on that side. - During the head impulse test, when the head is rapidly turned **to the right** (toward the affected side), the impaired VOR cannot maintain eye fixation on the target. - The eyes initially move **with the head** (to the right), then a visible **corrective saccade** (catch-up saccade) brings them **back to the left** to refixate on the target. - This corrective saccade is the **hallmark positive finding** in head impulse test for right vestibular dysfunction. *Head turned to left, corrective saccade to the right* - This would indicate a **left vestibular lesion**, not right vestibular neuronitis. - When turning the head to the left with left vestibular dysfunction, a corrective saccade to the right would be observed. *Head turned to right, no corrective saccade* - This would indicate **normal VOR function** on the right side. - A normal response shows no corrective saccade because the eyes maintain fixation throughout the head turn. - This is the **opposite** of what is expected in right vestibular neuronitis. *Head turned to left, no corrective saccade* - This indicates normal VOR function on the left side. - In right vestibular neuronitis, turning the head to the left (away from the affected side) typically shows **normal VOR** with no corrective saccade needed.

Q: A patient presents with conductive hearing loss, pulsatile tinnitus, and a positive Phelps sign. Based on the CT scan image provided, what is the most likely diagnosis?

Glomus Jugulare. ***Glomus Jugulare*** - The symptoms of **conductive hearing loss**, **pulsatile tinnitus**, and a **positive Phelps sign** (destruction of the bone separating the carotid artery from the jugular bulb on CT) are classic for a glomus jugulare tumor. - The CT scan image, showing a destructive lesion in the **jugular foramen** region, further supports this diagnosis, as these tumors originate from the paraganglia of the jugular bulb. *Glomus Tympanicum* - While it can cause conductive hearing loss and pulsatile tinnitus, a glomus tympanicum tumor is typically **confined to the middle ear cavity** and does not involve bone erosion of the jugular foramen as indicated by a positive Phelps sign. - The CT findings would show a mass in the middle ear, often behind an intact tympanic membrane, rather than extensive bone destruction in the jugular region. *Acoustic Neuroma* - This tumor, also known as a **vestibular schwannoma**, primarily causes **sensorineural hearing loss**, **tinnitus** (often non-pulsatile), and **balance issues**, not conductive hearing loss or pulsatile tinnitus. - An acoustic neuroma is located in the **cerebellopontine angle** and internal auditory canal, and the CT scan would show a mass in this specific location, not necessarily bone erosion of the jugular foramen. *Cholesteatoma* - A cholesteatoma is a **destructive, expanding growth of keratinizing squamous epithelium** in the middle ear or mastoid, typically presenting with **conductive hearing loss**, **otorrhea**, and sometimes headaches. - It does not typically cause pulsatile tinnitus unless it's very large and vascularized, nor does it present with the characteristic destruction of the jugular foramen seen with a positive Phelps sign.

Q: A patient with chronic nasal obstruction underwent a procedure 3 months ago and now presents with recurrent epistaxis, crusting, and the clinical image showing a septal perforation. What procedure was most likely carried out?

Submucosal resection (SMR). ***Submucosal resection (SMR)*** - **SMR** involves removing cartilage or bone from the nasal septum while preserving the septal mucosa. If both mucosal flaps are inadvertently damaged or devitalized during the procedure, it can lead to a **septal perforation** as a complication. - The symptoms of **recurrent epistaxis** and **crusting** are classic signs associated with compromised septal integrity and airflow changes due to a septal perforation, which commonly occurs weeks to months after such a procedure. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is primarily used to treat chronic sinusitis by opening and ventilating the sinuses; it does not directly involve the nasal septum in a way that typically causes perforation. - While complications are possible, a septal perforation is not a common or direct consequence of FESS, which focuses on ethmoid, maxillary, frontal, or sphenoid sinus drainage pathways. *Caldwell-Luc's procedure* - The **Caldwell-Luc procedure** involves an incision above the canine fossa to access the maxillary sinus. - It is specifically aimed at the maxillary sinus and does not involve surgical manipulation of the nasal septum that would lead to a septal perforation. *Turbinate reduction surgery* - **Turbinate reduction** procedures target the inferior turbinates to improve nasal airflow by reducing their size. - These procedures do not involve the nasal septum itself, so a septal perforation would not be a direct or common complication.

Q: A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?

CECT (Contrast-Enhanced CT). ***CECT (Contrast-Enhanced CT)*** - Given the history of recurrent nasal bleeding in an adolescent male suggestive of a **juvenile nasopharyngeal angiofibroma (JNA)**, CECT is the investigation of choice to delineate the tumor's extent, vascularity, and involvement of surrounding structures. - CECT provides crucial information for surgical planning and assessing intracranial extension due to the highly vascular nature of JNAs. *Biopsy* - Biopsy of a suspected angiofibroma is generally **contraindicated** due to the high risk of severe and uncontrolled hemorrhage because the tumor is highly vascular and lacks a true capsule. - The diagnosis of JNA is usually made based on clinical presentation and imaging findings. *X-ray* - **X-rays** (like plain radiographs of the sinuses) offer limited soft tissue detail and are **insufficient** to accurately visualize the extent or vascularity of a nasopharyngeal mass. - They may show some bony erosion but cannot provide the detailed information needed for diagnosis or surgical planning of a JNA. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is a **surgical procedure** used for treating chronic sinusitis and other sinonasal conditions, not primarily an investigative tool for a suspected tumor like JNA. - While endoscopy is used for initial visualization, **surgery** is a treatment, and detailed imaging must precede it to understand tumor boundaries.

Q: Identify the marked structure in the given image.

Coil. ***Coil*** - The marked structure appears to be a **cochlear implant's internal coil**, which is common in X-ray imaging of these devices. - The **cochlear implant internal coil** is crucial for transmitting processed sound signals via electromagnetic induction to the electrode array within the cochlea. *Electrode* - An **electrode array** is typically a thin, flexible wire with multiple contacts inserted into the cochlea, which is not what the arrow is pointing to directly. - While electrodes are part of a cochlear implant, the marked structure's shape and position are more consistent with the **internal coil** that connects to the electrode array. *Magnet* - A **magnet** is present in a cochlear implant system, typically in both the external processor and internal receiver, to hold these two components together through the skin. - Magnets usually appear as dense, circular structures in X-rays, often seen more anteriorly or superiorly to the coil for external component alignment. *Processor* - The **processor** for a cochlear implant is an external device worn behind the ear, not an implanted component visible on an X-ray. It processes sound and sends it to the internal coil. - The structures seen in the X-ray are **implanted components** of the cochlear implant, not the external sound processor.

Q: A patient presents with headaches, palpitations, hypertension, and urine VMA positivity. The biopsy findings are shown in the image. Which of the following statements is correct?

Associated with MEN 2A. ***Associated with MEN 2A*** - The clinical presentation (headaches, palpitations, hypertension) and positive **urine VMA (vanillylmandelic acid)** strongly suggest a **pheochromocytoma**. - Pheochromocytomas are tumors of the adrenal medulla that secrete catecholamines and are frequently associated with **Multiple Endocrine Neoplasia Type 2A (MEN 2A)**, along with medullary thyroid carcinoma and primary hyperparathyroidism. *Mostly malignant* - Pheochromocytomas are generally benign, with approximately **10% being malignant** ("rule of 10s"). - Malignancy is difficult to predict based on histology alone and is usually defined by the presence of **metastases**. *Mostly in children* - While pheochromocytomas can occur at any age, they are **more common in adults**, typically between 30 and 50 years old. - When they do occur in children, they are more often bilateral, extra-adrenal, or associated with genetic syndromes. *Mostly bilateral* - The majority of pheochromocytomas (approximately **90%**) are **unilateral**. - Bilateral pheochromocytomas are often seen in genetic syndromes such as **MEN 2**, von Hippel-Lindau disease, and neurofibromatosis type 1.

Question 1

Impaired gag reflex is seen due to a lesion in which cranial nerves?

Accepted Answer

CN IX & X

Answer

CN V&VI

Answer

CN X & XI

Answer

CN VII & VIII

Answer

CN XI & XII

Question 2

A nasal surgery was carried out with the incision shown in the image. What was the procedure likely carried out?

Accepted Answer

Open rhinoplasty

Answer

Submucosal resection (SMR)

Answer

FESS (Functional Endoscopic Sinus Surgery)

Answer

Caldwell-Luc's procedure

Question 3

In a patient with right vestibular neuronitis, what will be the finding on the head impulse test?

Accepted Answer

Head turned to right, corrective saccade to the left

Answer

Head turned to left, corrective saccade to the right

Answer

Head turned to right, no corrective saccade

Answer

Head turned to left, no corrective saccade

Question 4

A patient presents with conductive hearing loss, pulsatile tinnitus, and a positive Phelps sign. Based on the CT scan image provided, what is the most likely diagnosis?

Accepted Answer

Glomus Jugulare

Answer

Glomus Tympanicum

Answer

Acoustic Neuroma

Answer

Cholesteatoma

Question 5

A patient with chronic nasal obstruction underwent a procedure 3 months ago and now presents with recurrent epistaxis, crusting, and the clinical image showing a septal perforation. What procedure was most likely carried out?

Accepted Answer

Submucosal resection (SMR)

Answer

FESS (Functional Endoscopic Sinus Surgery)

Answer

Caldwell-Luc's procedure

Answer

Turbinate reduction surgery

Question 6

A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?

Accepted Answer

CECT (Contrast-Enhanced CT)

Answer

Biopsy

Answer

X-ray

Answer

FESS (Functional Endoscopic Sinus Surgery)

Question 7

Identify the marked structure in the given image.

Accepted Answer

Coil

Answer

Electrode

Answer

Magnet

Answer

Processor

Question 8

A 32-year-old female presents with a 2-month history of progressive, painless swelling in the left side of her neck. She also reports low-grade fever, night sweats, and unintentional weight loss. Physical examination reveals a firm, non-tender, immobile mass in the left cervical region, and multiple smaller lymph nodes in the supraclavicular area. Chest X-ray shows mediastinal widening, and a lymph node biopsy confirms the presence of Reed-Sternberg cells. What is the most appropriate management for this patient?

Accepted Answer

Hodgkin Lymphoma with the ABVD regimen

Answer

NHL with a highly aggressive chemotherapy regimen

Answer

NHL with Rituximab

Answer

Hodgkin Lymphoma with surgical excision only

Answer

Hodgkin Lymphoma with radiation therapy only

Question 9

A patient presents with headaches, palpitations, hypertension, and urine VMA positivity. The biopsy findings are shown in the image. Which of the following statements is correct?

Accepted Answer

Associated with MEN 2A

Answer

Mostly malignant

Answer

Mostly in children

Answer

Mostly bilateral

Question 10

Which of the following procedures would be difficult to perform based on the given Chest X-ray?

Accepted Answer

Tracheostomy

Answer

Laryngeal mask airway insertion

Answer

Ryle's tube insertion

Answer

Intubation

NEET-PG 2024

Anatomy

ENT

Internal Medicine

Pathology

Surgery