NEET-PG 2013 Practice Questions

Q: Which nerve does NOT carry referred ear pain?

Abducens nerve. ***Abducens nerve*** - The **abducens nerve (CN VI)** primarily controls the **lateral rectus muscle** of the eye, responsible for **abduction of the eyeball**. - It has **no sensory function** and, therefore, cannot carry referred pain from any region, including the ear. *Trigeminal nerve* - The **trigeminal nerve (CN V)**, particularly its **auriculotemporal branch**, provides sensory innervation to part of the external ear and temporomandibular joint, making it a common pathway for **referred otalgia** from dental or TMJ issues. - Pain from conditions like **trigeminal neuralgia**, **TMJ disorders**, or **dental caries** can be referred to the ear via this nerve. *Glossopharyngeal nerve* - The **glossopharyngeal nerve (CN IX)** supplies sensory innervation to the **middle ear**, pharynx, and posterior tongue. - Conditions affecting these areas, such as **glossopharyngeal neuralgia**, **tonsillitis**, or **pharyngitis**, can cause **referred ear pain**. *Vagus nerve* - The **vagus nerve (CN X)**, specifically the **auricular branch (Arnold's nerve)**, provides sensory innervation to a portion of the external auditory canal and concha. - Irritation of this nerve from conditions in the **larynx**, **pharynx**, **esophagus**, or **heart** can lead to referred ear pain.

Q: What is a specific indication for the use of a Bone-Anchored Hearing Aid (BAHA)?

Congenital canal atresia. ***Congenital canal atresia*** - **Congenital canal atresia** represents a classic, specific indication for BAHA because the ear canal is congenitally absent or severely stenosed, making conventional hearing aids impossible to fit or ineffective. - BAHA bypasses the absent ear canal entirely by transmitting sound vibrations directly to the **cochlea through bone conduction**, providing an ideal solution for this anatomical abnormality. *Bilateral conductive hearing loss* - While BAHA can be used for conductive hearing loss, **conventional hearing aids** are typically the first-line treatment when ear canals are intact and functional. - Bilateral cases often benefit from traditional amplification devices or **surgical correction** of the underlying conductive pathology before considering BAHA. *Unilateral sensorineural hearing loss* - BAHA is commonly used for **single-sided deafness (SSD)** to route sound from the deaf ear to the hearing ear via bone conduction using the **CROS principle**. - However, this indication is less specific than congenital canal atresia, as other treatment options like **conventional CROS hearing aids** may also be considered. *Conductive hearing loss due to other causes* - This option is too **broad and non-specific** as it encompasses many different etiologies of conductive hearing loss. - Many other causes of conductive hearing loss have **alternative treatments** such as surgical repair, conventional hearing aids, or medical management, making BAHA a secondary consideration.

Q: Electrode of cochlear implant is placed in:

Scala tympani. ***Scala tympani*** - The electrode array of a **cochlear implant** is carefully inserted into the **scala tympani** of the cochlea. - This placement allows the electrodes to directly stimulate the **spiral ganglion neurons**, bypassing damaged hair cells and transmitting electrical signals to the auditory nerve. *Horizontal semicircular canal* - The **horizontal semicircular canal** is part of the **vestibular system**, responsible for sensing angular head movements, not hearing. - Placing an electrode here would cause **vestibular dysfunction** and would not restore hearing. *Scala media* - The **scala media** (cochlear duct) contains the **organ of Corti** and **endolymph**, which has a high potassium concentration. - Inserting an electrode here would damage the delicate structures essential for natural sound transduction and could lead to electric potential imbalances. *Scala vestibuli* - The **scala vestibuli** is filled with **perilymph** and receives sound vibrations from the stapes. - While it's adjacent to the scala tympani, the **scala tympani** offers a safer and more direct path for optimal electrode insertion with less trauma to the sensory structures.

Q: Which of the following conditions is associated with objective tinnitus?

Glomus tumor. ***Glomus tumor*** - A glomus tumor is a **vascular tumor** that can cause turbulent blood flow, leading to a pulsatile, objective tinnitus that can be heard by an examiner. - The sound is often described as a **thumping or whooshing** sound synchronous with the patient's heartbeat. *Ménière's disease* - **Ménière's disease** is associated with subjective tinnitus, a ringing or roaring sensation perceptible only to the patient. - It is characterized by the triad of **vertigo, fluctuating hearing loss, and tinnitus**. *Acoustic neuroma* - An acoustic neuroma (vestibular schwannoma) typically causes **unilateral, subjective tinnitus**, often described as a high-pitched ringing. - It is a benign tumor on the **vestibulocochlear nerve** and is also associated with sensorineural hearing loss and balance issues. *Ear wax* - **Impacted ear wax** can cause subjective tinnitus due to its interference with sound conduction and resonance within the ear canal. - The tinnitus is not typically audible to an examiner, making it a **subjective finding**.

Q: Site of glomus jugulare tumor?

Hypotympanum. ***Hypotympanum*** - **Glomus jugulare tumor** is a paraganglioma arising from the **paraganglia** (chemoreceptor cells) located in the **adventitia of the jugular bulb** in the **jugular foramen**. - This anatomical location places the tumor in the **hypotympanum** (inferior compartment of the middle ear cavity), which lies directly above the jugular bulb [1]. - These tumors typically present with **pulsatile tinnitus**, **hearing loss**, and a **reddish-blue mass** behind the tympanic membrane (rising sun sign). - The hypotympanum extends from the floor of the middle ear to the level of the inferior margin of the tympanic membrane [1]. *Epitympanum* - The **epitympanum** (attic) is the **superior compartment** of the middle ear, located above the tympanic membrane [1]. - It contains the head of the **malleus** and body of the **incus** [1]. - **Glomus tympanicum tumors** (arising from paraganglia along the tympanic plexus on the promontory) may present here, but glomus jugulare tumors originate inferiorly in the hypotympanum. *Mesotympanum* - The **mesotympanum** is the **middle compartment** of the middle ear, at the level of the tympanic membrane. - It contains the **manubrium of malleus** and **long process of incus**. - While glomus jugulare tumors may extend into this region as they grow, their primary site of origin is the hypotympanum. *Internal ear* - The **internal ear** (inner ear) is located medial to the middle ear and contains the **cochlea**, **vestibule**, and **semicircular canals** [1]. - Advanced glomus jugulare tumors may erode into the inner ear causing **sensorineural hearing loss** and **vertigo**, but this is not their site of origin.

Q: Which of the following conditions is least likely to cause proptosis?

Myxoedema. ***Myxoedema*** - **Myxoedema** is associated with severe **hypothyroidism** and is characterized by non-pitting edema due to the accumulation of **glycosaminoglycans** in tissues. - While it can cause facial puffiness, it is **least likely** to cause **proptosis** as there is no direct mechanism for an increase in orbital contents to push the eye forward. *Grave's disease* - **Grave's disease** is the most common cause of **proptosis** due to **immune-mediated inflammation** and accumulation of **glycosaminoglycans** and fat in the orbital tissues, leading to expansion. - This condition specifically affects the **extraocular muscles** and fat, causing bulging of the eyes. *Sarcoidosis* - **Orbital sarcoidosis** can cause **proptosis** due to the formation of **granulomas** within the orbit, leading to mass effect and inflammation. - It can affect any part of the eye and orbit, leading to varied clinical presentations including axial or non-axial globe displacement. *Pituitary adenoma* - A **pituitary adenoma** itself does not directly cause proptosis as it is located in the **sella turcica**, posterior to the orbits. - However, **large adenomas** can cause proptosis indirectly if they invade the **cavernous sinus** and obstruct venous return from the orbit, or if they are associated with **acromegaly**, which can lead to bony overgrowth of the orbital structures and surrounding tissues.

Q: What is the drug of choice for treating intermediate uveitis?

Systemic steroids. ***Systemic steroids*** - **Systemic steroids** are the **drug of choice** for treating intermediate uveitis, especially when inflammation is significant or vision is threatened. - They effectively suppress the expansive **intraocular inflammation** typical of intermediate uveitis, which often involves the **vitreous** and **peripheral retina**. *Atropine* - **Atropine** is a **cycloplegic agent** primarily used to relieve ciliary spasm and prevent synechiae formation in anterior uveitis. - It does not address the underlying **inflammation** of intermediate uveitis, which is located more posteriorly. *Antibiotics* - **Antibiotics** are used to treat bacterial infections and are not indicated for **intermediate uveitis**, which is typically an **inflammatory** or **autoimmune disorder**. - They would be appropriate only if the uveitis were secondary to an **infectious cause**, which is not the primary characteristic of intermediate uveitis. *Topical steroids* - **Topical steroids** are effective for **anterior uveitis** but often fail to reach sufficient concentrations in the **vitreous** and **peripheral retina** to control the inflammation of intermediate uveitis. - **Intermediate uveitis** primarily affects the ciliary body, vitreous, and peripheral retina, requiring **systemic agents** for adequate therapeutic effect.

Q: What is the thinnest portion of the sclera?

Posterior to the rectus muscle insertion. ***Posterior to the rectus muscle insertion*** - The sclera is thinnest immediately **posterior to the insertion of the rectus muscles**, where it is about 0.3 mm thick. - This area is clinically relevant as it is a common site for globe rupture during trauma. *Anterior to the rectus muscle insertion* - The sclera is relatively thick in this region, measuring around **0.6 mm thick**. - It provides robust support and attachment for the rectus muscles. *At the posterior pole* - At the posterior pole, the sclera is the **thickest**, reaching about 1.0 mm, especially around the optic nerve. - This thickness is necessary to protect the delicate neural structures exiting the eye. *At the limbus* - The sclera-corneal junction, or **limbus**, has an intermediate thickness, around **0.8 mm**. - This area is critical for surgical procedures but is not the thinnest point.

Q: Normal level of visual acuity is attained at which age

6 years. ***6 years*** - **Normal adult visual acuity (20/20 or 6/6)** is typically achieved around the age of **6 years** as the visual system fully matures. - This age allows for the complete development of **foveal vision** and **binocular functions**. *6 months* - At 6 months of age, an infant's visual acuity is still developing and is typically around **20/200 to 20/400**. - While significant visual development occurs by this age, including **face recognition and tracking objects**, it is not yet at adult levels. *1 year* - By one year, visual acuity improves to approximately **20/50 to 20/100**. - Infants at this age are able to **distinguish fine details** and have improved **depth perception**, but full maturity is still some years away. *3 years* - At 3 years of age, visual acuity is generally around **20/30 to 20/40**. - Children at this stage are able to perform **visual tasks** like drawing and recognizing letters, but subtle refinements are still ongoing.

Q: Which condition is characterized by a specific radiological appearance resembling a sunburst pattern?

Osteosarcoma. ***Osteosarcoma*** - **Osteosarcoma** is known for its classic radiological findings, including the **sunburst (rising sun)** or **spiculated periosteal reaction**, where new bone forms perpendicular to the cortex. - Another characteristic finding is **Codman's triangle**, which is a triangular elevation of the periosteum visible on X-ray. *Chondrosarcoma* - **Chondrosarcomas** are typically characterized by a **"rings and arcs"** pattern of calcification within the cartilaginous matrix on imaging studies. - They tend to appear as lobular masses with endosteal scalloping and soft tissue components rather than the sunburst pattern. *Ewing's sarcoma* - **Ewing's sarcoma** classically presents with an **"onion skin" (lamellated)** periosteal reaction due to layers of parallel new bone formation. - It often appears as an ill-defined lytic lesion with cortical destruction, differing from the sunburst appearance. *Fibrosarcoma* - **Fibrosarcomas** are typically **lytic lesions** with aggressive cortical destruction and soft tissue involvement. - They generally do not produce characteristic periosteal reactions like the sunburst or onion skin appearance, often presenting as non-specific destructive lesions.

Question 1

Which nerve does NOT carry referred ear pain?

Accepted Answer

Abducens nerve

Answer

Glossopharyngeal nerve

Answer

Vagus nerve

Answer

Trigeminal nerve

Question 2

What is a specific indication for the use of a Bone-Anchored Hearing Aid (BAHA)?

Accepted Answer

Congenital canal atresia

Answer

Bilateral conductive hearing loss

Answer

Unilateral sensorineural hearing loss

Answer

Conductive hearing loss due to other causes

Question 3

Electrode of cochlear implant is placed in:

Accepted Answer

Scala tympani

Answer

Horizontal semicircular canal

Answer

Scala media

Answer

Scala vestibuli

Question 4

Which of the following conditions is associated with objective tinnitus?

Accepted Answer

Glomus tumor

Answer

Acoustic neuroma

Answer

Ear wax

Answer

Ménière's disease

Question 5

Site of glomus jugulare tumor?

Accepted Answer

Hypotympanum

Answer

Epitympanum

Answer

Mesotympanum

Answer

Internal ear

Question 6

Which of the following conditions is least likely to cause proptosis?

Accepted Answer

Myxoedema

Answer

Sarcoidosis

Answer

Grave's disease

Answer

Pituitary adenoma

Question 7

What is the drug of choice for treating intermediate uveitis?

Accepted Answer

Systemic steroids

Answer

Atropine

Answer

Antibiotics

Answer

Topical steroids

Question 8

What is the thinnest portion of the sclera?

Accepted Answer

Posterior to the rectus muscle insertion

Answer

Anterior to the rectus muscle insertion

Answer

At the posterior pole

Answer

At the limbus

Question 9

Normal level of visual acuity is attained at which age

Accepted Answer

6 years

Answer

6 months

Answer

1 year

Answer

3 years

Question 10

Which condition is characterized by a specific radiological appearance resembling a sunburst pattern?

Accepted Answer

Osteosarcoma

Answer

Chondrosarcoma

Answer

Fibrosarcoma

Answer

Ewing's sarcoma

NEET-PG 2013

Anatomy

ENT

Ophthalmology

Radiology