NEET-PG 2013 Practice Questions

Q: Which structure prevents spread of infection from middle ear to brain?

Tegmen tympani. ***Tegmen tympani*** - The **tegmen tympani** is a thin plate of bone forming the roof of the middle ear cavity, separating it from the **middle cranial fossa** and the brain. - Its primary function is to act as a **bony barrier**, preventing upward spread of infection from the middle ear space into the intracranial cavity. *Cribriform plate* - The **cribriform plate** is part of the ethmoid bone, located in the anterior cranial fossa, and is perforated by the **olfactory nerves**. - It does not form a boundary to the middle ear cavity and is not involved in preventing infection spread from the middle ear. *Fundus tympani* - This term is not a standard anatomical landmark. The **floor of the tympanic cavity**, or **fundus tympani**, separates the middle ear from the **internal jugular vein**. - It does not prevent the spread of infection to the brain but rather to structures below the middle ear. *Petrous apex* - The **petrous apex** is the very tip of the petrous part of the temporal bone, which houses the cochlea and vestibule. - While part of the temporal bone, it is not the direct barrier between the middle ear cavity and the brain; its involvement in infection spread is typically due to **petrous apexitis**, a distinct complication.

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: In head injury, unilateral dilatation of the pupil is seen due to?

Oculomotor nerve compression. Oculomotor nerve compression - Unilateral pupillary dilation, often referred to as a **blown pupil**, is a classic sign of **oculomotor nerve (CN III) compression** due to increased intracranial pressure, typically from a **herniating uncus** [1]. - The parasympathetic fibers responsible for pupillary constriction run on the superficial aspect of the oculomotor nerve and are thus vulnerable to extrinsic compression [1], [2]. *Ophthalmic N. compression* - The **ophthalmic nerve (CN V1)** is a sensory nerve responsible for sensation to the forehead, scalp, upper eyelid, and cornea, not pupillary control. - Compression of this nerve would cause **sensory deficits** in its distribution and potentially abolish the **corneal reflex**, but not pupillary dilation. *Trigeminal N. compression* - The **trigeminal nerve (CN V)** is primarily responsible for sensation to the face and motor control of the muscles of mastication. - Compression would lead to **facial numbness or pain** and **weakness in chewing**, with no direct impact on pupillary size. *None of the options* - This option is incorrect because oculomotor nerve compression is a well-established cause of unilateral pupillary dilation in head injuries [1].

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

Which structure prevents spread of infection from middle ear to brain?

Accepted Answer

Tegmen tympani

Answer

Cribriform plate

Answer

Fundus tympani

Answer

Petrous apex

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 statements about laryngeal tuberculosis (TB) is true?

Accepted Answer

It presents with a mouse-nibbled appearance of the vocal cord.

Answer

It commonly involves the posterior 1/3 of the vocal cord.

Answer

It is more common in females.

Answer

It is a common form of tuberculosis.

Question 8

In head injury, unilateral dilatation of the pupil is seen due to?

Accepted Answer

Oculomotor nerve compression

Answer

Ophthalmic N. compression

Answer

Trigeminal N. compression

Answer

None of the options

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

Anatomy

ENT

Internal Medicine

Psychiatry

Radiology