NEET-PG 2013 Practice Questions

Q: Which of the following arteries does NOT contribute to Little's area?

Posterior Ethmoidal artery. Posterior Ethmoidal artery - The posterior ethmoidal artery primarily supplies the posterior ethmoidal cells and part of the sphenoid sinus, but it does not contribute to the vascular plexus in Little's area. - Little's area, also known as Kiesselbach's plexus, is formed by anastomoses of several arteries on the anterior nasal septum. Sphenopalatine artery - The sphenopalatine artery, a terminal branch of the maxillary artery, is a major contributor to Little's area through its septal branch. - It supplies a significant portion of the nasal septum and is frequently involved in posterior epistaxis. Greater palatine artery - The greater palatine artery, a branch of the descending palatine artery (from the maxillary artery), enters the nasal cavity through the incisive canal and contributes to Little's area on the nasal septum. - It primarily supplies the hard palate and then anastomoses with other vessels in the anterior nasal septum. Anterior Ethmoidal artery - The anterior ethmoidal artery, a branch of the ophthalmic artery, is a key contributor to Little's area. - It supplies the anterior and middle ethmoidal cells and also contributes to the blood supply of the dura mater.

Q: Which of the following statements is true about rhinophyma?

Acne rosacea. ***Acne rosacea*** - **Rhinophyma** is a severe form of **acne rosacea**, characterized by sebaceous gland hypertrophy and connective tissue hyperplasia on the nose. - It specifically represents the **phymatous subtype** of rosacea, which involves thickening of the skin. *Premalignant* - Rhinophyma itself is generally **not considered premalignant** to skin cancer. - While skin cancers like **basal cell carcinoma** can rarely occur within rhinophyma, the condition itself does not inherently transform into malignancy. *Common in alcoholics* - This is a **common misconception**; while often associated with heavy alcohol use, there is no direct causal link. - The development of rhinophyma is primarily driven by the underlying pathogenesis of **rosacea**, not alcohol consumption. *Fungal etiology* - Rhinophyma is primarily an inflammatory skin condition, not caused by **fungal infection**. - Its etiology is complex, involving genetics, environmental triggers, and vascular dysregulation, but **microbial involvement** is typically bacterial (e.g., Demodex mites) rather than fungal.

Q: What is the condition characterized by the hypertrophy of sebaceous glands?

Sebaceous hyperplasia. ***Sebaceous hyperplasia*** - This condition is characterized by the **enlargement (hypertrophy)** of normal sebaceous glands, often appearing as yellowish-white papules with a central umbilication. - It commonly occurs on the **face of older adults**, particularly on the forehead and cheeks, and is a benign condition. *Rhinosporidiosis* - This is a **chronic granulomatous disease** caused by the fungus *Rhinosporidium seeberi*, primarily affecting the **mucous membranes** of the nose and nasopharynx. - It presents as **friable, polypoidal masses** with a characteristic "strawberry-like" appearance due to small white spots (sporangia), not sebaceous gland hypertrophy. *Tubercular infection* - A tubercular infection, particularly cutaneous tuberculosis, can manifest in various forms, including **lupus vulgaris**, scrofuloderma, or tuberculosis cutis verrucosa. - These presentations involve **granulomatous inflammation** and tissue destruction, not isolated hypertrophy of sebaceous glands. *Nasopharyngeal angiofibroma* - This is a **rare, benign, highly vascular tumor** that originates in the nasopharynx, predominantly affecting adolescent males. - It typically presents with symptoms like **epistaxis** and **nasal obstruction**, and is composed of fibrous and vascular tissue, not sebaceous glands.

Q: What is not true about the use of intranasal steroids in nasal polyposis?

Effective in all types of nasal polyps. ***Effective in all types of nasal polyps*** - Intranasal steroids are primarily effective in nasal polyps with an **eosinophilic inflammatory component**, which is the most common type. - They are **not effective in all types** - efficacy is significantly reduced in polyps with **neutrophilic inflammation** or those related to conditions like **cystic fibrosis**, reflecting different underlying pathologies. - This statement is **FALSE**, making it the correct answer to this negation question. *May cause nasal irritation* - **Nasal irritation**, including **burning, stinging**, or **dryness**, is a common local side effect associated with the use of intranasal steroids. - Other local side effects can include **epistaxis** (nosebleeds) and mucosal atrophy, though less common. - This statement is **TRUE**. *Reduce recurrence* - **Intranasal steroids** are crucial in **reducing the recurrence** of nasal polyps after surgical removal. - Their anti-inflammatory action helps to **control the underlying inflammation** that contributes to polyp formation. - This statement is **TRUE**. *Most effective in eosinophilically predominant polyps* - Intranasal steroids primarily target the **eosinophilic inflammatory pathway**, which is characteristic of the majority of **chronic rhinosinusitis with nasal polyps (CRSwNP)**. - While they have **maximal efficacy** in eosinophilic polyps, they may have limited benefit in mixed inflammatory patterns. - Their efficacy is significantly reduced in polyps that are predominantly **neutrophilic** or associated with systemic conditions like **cystic fibrosis**, as these involve different inflammatory mechanisms. - This statement is **TRUE**.

Q: Which of the following statements about Rhinoscleroma is false?

More common in tropical regions. ***More common in tropical regions*** - While rhinoscleroma is endemic in certain regions, it is more commonly found in **temperate and subtropical climates**, particularly in Eastern Europe, Central and South America, and parts of Africa and Asia, rather than exclusively tropical areas. - The prevalence is linked to socioeconomic factors and poor hygiene rather than strictly temperature-based climate zones. *Mikulicz cells* - The presence of **Mikulicz cells** is a characteristic histopathological feature of rhinoscleroma. - These are large macrophages with a clear, foamy cytoplasm containing numerous bacilli, which are pathognomonic for the disease. *Woody nose* - **Woody nose** (or "saddle nose" deformity in late stages) is a clinical feature associated with the advanced stages of rhinoscleroma. - The disease causes chronic inflammation and granuloma formation, leading to firm, indurated infiltrates that can result in this characteristic nasal deformity. *Caused by bacteria* - Rhinoscleroma is indeed caused by the bacterium **_Klebsiella rhinoscleromatis_**, a gram-negative rod. - It is an infectious disease primarily affecting the upper respiratory tract.

Q: All are seen in Samters triad except?

Bacterial infection. ***Bacterial infection*** - **Samter's triad**, also known as aspirin-exacerbated respiratory disease (AERD), consists of **asthma**, **nasal polyps**, and **aspirin sensitivity** (or NSAID sensitivity) [1]. - **Bacterial infection** is not a component of Samter's triad, although patients with nasal polyps may be more prone to secondary bacterial sinusitis. *Asthma* - **Asthma** is one of the three main components of Samter's triad, typically becoming more symptomatic after aspirin ingestion [1]. - Patients experience **bronchoconstriction** and worsening respiratory symptoms. *Nasal polyp* - **Nasal polyps** are a characteristic feature of Samter's triad, often extensive and recurrent [1]. - They contribute to nasal obstruction and chronic rhinosinusitis. *Aspirin sensitivity* - **Aspirin sensitivity** (or NSAID sensitivity) is the third key component, where ingestion of aspirin or other NSAIDs triggers severe respiratory reactions [1]. - This sensitivity is due to an abnormal arachidonic acid metabolism pathway involving **leukotrienes**.

Q: Posterior epistaxis occurs from:

Woodruff's plexus. ***Woodruff's plexus*** - **Woodruff's plexus** is a collection of large, often friable veins located on the **posterior aspect of the lateral wall of the nasal cavity**, making it the most common anatomical site for **posterior epistaxis**. - Bleeding from this plexus is typically more severe and difficult to control than anterior epistaxis due to the larger vessel size and posterior location. - Located in the **posterolateral nasal cavity** near the posterior end of the inferior turbinate. *Kiesselbach's plexus* - **Kiesselbach's plexus** (also known as Little's area) is located on the **anterior nasal septum** and is the most common site for **anterior epistaxis**. - This is an anastomotic network of vessels from multiple arterial sources in the anterior nasal cavity. - Bleeding from this plexus is usually less severe and often responds to local pressure or cauterization. *Sphenopalatine artery* - The **sphenopalatine artery** is the terminal branch of the maxillary artery and is the primary arterial supply to the posterior nasal cavity. - While it supplies the area where posterior epistaxis occurs, the venous **Woodruff's plexus** is the specific anatomical structure most commonly associated with posterior epistaxis. - The sphenopalatine artery may require ligation or embolization in severe posterior epistaxis cases. *Little's area* - **Little's area** is another name for **Kiesselbach's plexus** and is located on the **anterior nasal septum**, primarily responsible for anterior epistaxis. - This area is highly vascularized by anastomoses of the anterior ethmoidal, sphenopalatine, greater palatine, superior labial, and septal branches of arteries. - Prone to bleeding from minor trauma, digital manipulation, or mucosal dryness.

Q: Which of the following is a predisposing factor for nasal myiasis?

Atrophic rhinitis. ***Atrophic rhinitis*** - **Atrophic rhinitis** leads to thinning and drying of the nasal mucosa, creating a favorable environment for **fly larvae (maggots)** to infest. - The **crusting and foul odor** associated with atrophic rhinitis can attract flies, making the nasal cavity susceptible to myiasis. *Allergic rhinitis* - Characterized by **inflammation and watery discharge** due to allergen exposure. It does not create the tissue damage or conducive environment for myiasis. - While it causes nasal symptoms, it generally **does not involve tissue necrosis** or open lesions that would attract flies for oviposition. *Vasomotor rhinitis* - Involves **non-allergic triggers** causing nasal congestion, sneezing, and runny nose, often due to autonomic nervous system dysfunction. - There is **no tissue destruction or mucosal atrophy** that would predispose to myiasis. *Rhinitis medicamentosa* - Results from **overuse of topical decongestant sprays**, leading to rebound congestion and chronic inflammation. - While it causes nasal irritation, it does **not typically involve the extensive mucosal damage or open wounds** that attract flies for myiasis.

Q: In which condition is mulberry nasal mucosa typically observed?

Lupus vulgaris. ***Lupus vulgaris*** - **Mulberry nasal mucosa** is a **pathognomonic finding** in **lupus vulgaris**, a form of cutaneous tuberculosis affecting the nasal mucosa. - The mucosa shows characteristic **reddish-brown, soft nodules** that resemble mulberries, with a typical **apple-jelly appearance on diascopy**. - Lesions are **persistent, slowly progressive**, and may cause destruction of the nasal cartilage if untreated. *Vasomotor rhinitis* - **Vasomotor rhinitis** (non-allergic rhinitis) presents with **pale, bluish, or boggy nasal mucosa**, not the mulberry appearance. - Caused by **autonomic nervous system dysregulation**, leading to nasal congestion and rhinorrhea triggered by non-allergic stimuli. - The mucosal changes are **diffusely edematous** rather than nodular. *Atrophic rhinitis* - **Atrophic rhinitis** involves progressive atrophy of the nasal mucosa and underlying bone. - Mucosa appears **pale, dry, smooth, and shiny** with thick crusts (ozena in secondary form). - Wide nasal cavities with paradoxical nasal obstruction, **not mulberry-like nodular changes**. *Allergic rhinitis* - **Allergic rhinitis** typically shows **pale, edematous, bluish-gray mucosa** with watery discharge. - Caused by **IgE-mediated hypersensitivity** to environmental allergens. - Mucosa may appear **boggy but not nodular or mulberry-like**.

Q: What is the purpose of the Queckenstedt test?

Spinal block. ***Spinal block*** - The Queckenstedt test was historically used to evaluate for a **spinal block**, which is an obstruction to the free flow of **cerebrospinal fluid (CSF)** in the subarachnoid space. - It involves observing the rise in **CSF pressure** in response to compression of the jugular veins; a blunted or absent rise suggests a block. *Glomus tumor* - **Glomus tumors** are usually benign and arise from glomus bodies, often presenting as painful lesions in the nail bed. - Their diagnosis is typically made through **imaging** and **biopsy**, not specific pressure tests. *Otosclerosis* - **Otosclerosis** is a condition causing progressive hearing loss due to abnormal bone growth in the middle ear. - Diagnosis involves **audiometry** and **tympanometry**, and it is unrelated to CSF flow or spinal blocks. *Acoustic neuroma* - An **acoustic neuroma** is a benign tumor of the vestibulocochlear nerve (cranial nerve VIII) that causes hearing loss, tinnitus, and balance issues. - Diagnosis relies on **MRI of the brain**, and the Queckenstedt test has no role in its evaluation.

Question 1

Which of the following arteries does NOT contribute to Little's area?

Accepted Answer

Posterior Ethmoidal artery

Answer

Sphenopalatine artery

Answer

Greater palatine artery

Answer

Anterior Ethmoidal artery

Question 2

Which of the following statements is true about rhinophyma?

Accepted Answer

Acne rosacea

Answer

Premalignant

Answer

Common in alcoholics

Answer

Fungal etiology

Question 3

What is the condition characterized by the hypertrophy of sebaceous glands?

Accepted Answer

Sebaceous hyperplasia

Answer

Rhinosporidiosis

Answer

Tubercular infection

Answer

Nasopharyngeal angiofibroma

Question 4

What is not true about the use of intranasal steroids in nasal polyposis?

Accepted Answer

Effective in all types of nasal polyps

Answer

May cause nasal irritation

Answer

Reduce recurrence

Answer

Most effective in eosinophilically predominant polyps

Question 5

Which of the following statements about Rhinoscleroma is false?

Accepted Answer

More common in tropical regions

Answer

Woody nose

Answer

Mikulicz cells

Answer

Caused by bacteria

Question 6

All are seen in Samters triad except?

Accepted Answer

Bacterial infection

Answer

Nasal polyp

Answer

Aspirin sensitivity

Answer

Asthma

Question 7

Posterior epistaxis occurs from:

Accepted Answer

Woodruff's plexus

Answer

Kiesselbach's plexus

Answer

Sphenopalatine artery

Answer

Little's area

Question 8

Which of the following is a predisposing factor for nasal myiasis?

Accepted Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Answer

Vasomotor rhinitis

Answer

Rhinitis medicamentosa

Question 9

In which condition is mulberry nasal mucosa typically observed?

Accepted Answer

Lupus vulgaris

Answer

Vasomotor rhinitis

Answer

Atrophic rhinitis

Answer

Allergic rhinitis

Question 10

What is the purpose of the Queckenstedt test?

Accepted Answer

Spinal block

Answer

Glomus tumor

Answer

Otosclerosis

Answer

Acoustic neuroma

NEET-PG 2013

Anatomy

Dermatology

ENT

Internal Medicine