NEET-PG 2017 Practice Questions

Q: The test performed below shows testing of which of the following nerve: (Recent NEET Pattern 2016-17)

Ulnar nerve. ***Ulnar nerve*** - The image shows a patient with inability to adequately flex the **ring and little fingers**, a classic sign of **ulnar nerve palsy**. This is known as the **"ulnar claw"** when the patient attempts to make a fist or extend the fingers. - The ulnar nerve innervates most of the **intrinsic hand muscles**, including the **interossei** and the **medial two lumbricals (ring and little fingers)**, which are responsible for flexion at the metacarpophalangeal joints and extension at the interphalangeal joints of these digits. *Median nerve* - **Median nerve injury** typically results in inability to **oppose the thumb** (ape hand deformity) and sensory loss over the radial three and a half digits. - It affects the **flexor muscles of the forearm** and the **thenar muscles**, not primarily the ring and little finger flexion shown. *Radial nerve* - **Radial nerve injury** causes **wrist drop** and **finger drop** due to paralysis of the extensors of the wrist and fingers. - It primarily affects **extension** of the wrist and fingers, rather than the intrinsic hand function of flexion shown in the image. *Axillary nerve* - The **axillary nerve** primarily innervates the **deltoid muscle** and **teres minor**, responsible for shoulder abduction and external rotation. - Injury to the axillary nerve would result in **shoulder weakness** and sensory loss over the lateral shoulder, with no direct impact on hand or finger function.

Q: All of the following are correct about the image shown except:

High pitched expiratory stridor. ***High pitched expiratory stridor*** - The image depicts an **omega-shaped epiglottis** and collapsed aryepiglottic folds, consistent with **laryngomalacia**. - Laryngomalacia typically presents with **inspiratory stridor**, not expiratory, resulting from airway collapse during inspiration. - **This is the EXCEPT answer** - high-pitched expiratory stridor is NOT a feature of laryngomalacia. *Omega shaped epiglottis* - The image clearly shows an **omega-shaped epiglottis**, a characteristic feature of **laryngomalacia**. - This anatomical variation contributes to the collapse of supraglottic structures during inspiration. *Cry is normal* - In laryngomalacia, the **vocal cords** themselves are not affected, so the **cry typically remains normal**. - The abnormal sounds (stridor) arise from the supraglottic structures, not the vocal cord function during crying. *10% cases need surgery due to development of OSA or Cor Pulmonale* - While most cases of laryngomalacia are self-limiting, approximately **10% of infants may require surgical intervention** (supraglottoplasty). - This is usually due to severe symptoms like **obstructive sleep apnea (OSA)**, failure to thrive, or the rare development of **cor pulmonale**.

Q: What is correct about the fracture shown in the figure?

A= Bennett fracture, B= Rolando fracture. ***A= Bennett fracture, B= Rolando fracture*** * **Bennett fracture** (A) is an **intra-articular fracture** of the base of the first metacarpal bone with a characteristic **two-part fracture** pattern. It involves a small fragment of the metacarpal base remaining attached to the carpometacarpal joint, while the rest of the metacarpal is dislocated. * **Rolando fracture** (B) is a **comminuted intra-articular fracture** at the base of the first metacarpal. It is characterized by a **Y or T-shaped fracture pattern**, indicating a more complex, three-part or more fragment involvement compared to a Bennett fracture. *A= Rolando fracture, B= Bennett fracture* * This option incorrectly identifies A as a Rolando fracture; Image A clearly shows a **two-part fracture** typical of a Bennett fracture, not the comminuted pattern of a Rolando. * Similarly, B is incorrectly identified as a Bennett fracture as it depicts a **multi-fragmented, Y-shaped fracture**, which defines a Rolando fracture. *A= Boxer's fracture, B= Bennett fracture* * **Boxer's fracture** is a fracture of the **neck of the fifth metacarpal**, which is not depicted in either image A or B. Both images show fractures at the base of the first metacarpal. * Image A is a **Bennett fracture**, not a Boxer's fracture, and B is a **Rolando fracture**, not a Bennett fracture. *A= Bennett fracture, B= Boxer's fracture* * While A is correctly identified as a **Bennett fracture**, B is incorrectly identified as a Boxer's fracture. * As previously stated, a **Boxer's fracture affects the fifth metacarpal**, whereas image B clearly shows a fracture of the first metacarpal base with multiple fragments.

Q: The given nature of injury will lead to the development of:

Mallet finger. ***Mallet finger*** - The image shows a **rupture of the extensor tendon** at its insertion into the distal phalanx, or an avulsion fracture of the distal phalanx, causing an inability to extend the distal interphalangeal (DIP) joint. - This injury results in the characteristic **flexion deformity** of the DIP joint, known as mallet finger. *Jersey finger* - This injury involves the **rupture of the flexor digitorum profundus tendon** from its insertion at the base of the distal phalanx. - Patients cannot actively **flex their DIP joint**, unlike the extensor tendon injury shown. *Jammed finger* - This is a general term for an **axial load injury** to the finger, usually causing a sprain or mild fracture without a specific tendon rupture as depicted. - It typically results from impact on the fingertip, leading to **ligamentous injury** or joint capsule damage. *Boxer knuckle* - **Boxer's knuckle** refers to a sagital band rupture at the metacarpophalangeal (MCP) joint, affecting the central slip of the extensor tendon. - This injury primarily involves the **MCP joint** and not the DIP joint, as shown in the image.

Q: The contracture shown in the image is associated with all except:

Table top test is negative. ***Table top test is negative*** - The image shows a hand affected by **Dupuytren's contracture**, characterized by fixed flexion deformities of the finger joints. - In Dupuytren's contracture, the **tabletop test** is typically **positive** (meaning the hand cannot be laid flat on a table) when the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint contracture exceeds 30 degrees, indicating significant fascial thickening and shortening. *Seen in cirrhosis* - **Dupuytren's contracture** is indeed associated with conditions like **alcoholism** and **liver cirrhosis**, though the exact pathophysiological link is not fully understood. - Other associated conditions include diabetes mellitus, manual labor, and certain anti-epileptic medications. *Involves the ring and little finger* - Dupuytren's contracture most commonly affects the **ulnar side of the hand**, particularly the **ring finger** and **little finger**, due to fibrosis and shortening of the palmar fascia. - It can also involve the middle finger and rarely the index finger and thumb. *Clostridial collagenase for resolution* - **Collagenase clostridium histolyticum (CCH)**, derived from *Clostridium histolyticum*, is an approved non-surgical treatment for Dupuytren's contracture. - It works by injecting the enzyme directly into the palmar cord to **dissolve the collagen fibers** responsible for the contracture, allowing for manipulation to release the contracture.

Q: Comment on the diagnosis based on examination findings shown below: (Recent NEET Pattern 2016-17)

Volkmann ischemic contracture. ***Volkmann ischemic contracture*** - The images show a **fixed flexion deformity of the wrist and fingers**, along with **forearm pronation**, which is characteristic of Volkmann's ischemic contracture. - This condition results from **ischemia to the forearm muscles**, leading to muscle necrosis and subsequent fibrosis and contracture. *Ulnar tunnel syndrome* - This syndrome involves compression of the **ulnar nerve** at the wrist. - Symptoms typically include **numbness and tingling in the ring and little fingers**, and hand weakness, which are not depicted as the primary finding here. *Cubital tunnel syndrome* - This condition involves compression of the **ulnar nerve** at the elbow. - It presents with similar sensory and motor deficits to ulnar tunnel syndrome but specifically related to the elbow, not the characteristic fixed deformity shown. *Wartenberg's syndrome* - Also known as **superficial radial nerve entrapment**, it involves compression of the superficial branch of the radial nerve. - This typically causes **sensory symptoms** (pain, numbness, paresthesia) on the back of the hand and thumb, without the gross motor contracture seen in the images.

Q: A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis? (Recent NEET Pattern 2016-17)

Monteggia fracture. ***Monteggia fracture*** - This classic injury pattern shows **fracture of the ulnar shaft** with **dislocation of the radial head**, more commonly seen in children due to their ligamentous laxity and softer bones. - Diagnosis is confirmed using the **radiocapitellar line test** - a line drawn through the center of the radial head should pass through the capitellum on all X-ray views; disruption indicates radial head dislocation. *Colles fracture* - A Colles fracture involves a **fracture of the distal radius** with **dorsal displacement** of the distal fragment, typically occurring from a fall on an outstretched hand in elderly patients. - The X-ray findings clearly show an **ulnar shaft fracture** with **radial head dislocation**, not a distal radial fracture pattern. *Smith's fracture* - A Smith's fracture is a **distal radius fracture** with **volar (palmar) displacement** of the distal fragment, sometimes called a "reverse Colles fracture." - This diagnosis is incorrect because the image demonstrates a **midshaft ulnar fracture** with **proximal radioulnar joint disruption**, not distal radial pathology. *Galeazzi's fracture* - A Galeazzi fracture involves a **fracture of the radius** (usually distal third) combined with **dislocation of the distal radioulnar joint (DRUJ)**. - This pattern is distinct from the current case, which shows **ulnar fracture** with **radial head dislocation** at the **proximal radioulnar joint**, making it a Monteggia rather than Galeazzi injury.

Q: The given X-ray of paranasal sinuses shows which view?

Waters' view. ***Waters' view*** - This view, also known as the **occipitomental view**, is primarily used to visualize the **maxillary sinuses**. - Key features include the **maxillary sinuses** being projected above the petrous ridges, allowing clear visualization of their floors and the inferolateral orbital walls. - The patient's mouth is open in this view, and the **petrous pyramids are projected below the maxillary sinuses**. *Caldwell view* - Also known as the **occipitofrontal view**, it primarily visualizes the **frontal sinuses** and anterior ethmoid air cells. - In a Caldwell view, the **petrous ridges** obscure the lower third of the orbits. *Orthopantomogram* - An **Orthopantomogram (OPG)** is a panoramic dental X-ray that shows all the teeth and surrounding bones in a single image. - It provides a broad view of the **mandible** and **maxilla**, which is not depicted in the image. *Luc's View* - Luc's view is an uncommon projection, sometimes referring to a **lateral view of the maxillary sinus** or a **basal/submentovertex view**. - It is used to visualize the **sphenoid sinus** and **posterior structures**, not the maxillary sinuses as prominently shown in this image.

Question 1

The test performed below shows testing of which of the following nerve: (Recent NEET Pattern 2016-17)

Accepted Answer

Ulnar nerve

Answer

Median nerve

Answer

Radial nerve

Answer

Axillary nerve

Question 2

All are contraindications to the procedure shown below except:

Accepted Answer

Antral cyst

Answer

Acute maxillary sinusitis

Answer

Fractured maxilla

Answer

Children less than 3 years

Question 3

All of the following are correct about the image shown except:

Accepted Answer

High pitched expiratory stridor

Answer

Omega shaped epiglottis

Answer

Cry is normal

Answer

10% cases need surgery due to development of OSA or Cor Pulmonale

Question 4

All are correct about the procedure performed in the patient except:

Accepted Answer

Skin incision is a vertical midline incision from cricoid cartilage to suprasternal notch

Answer

Skin incision is not sutured to prevent surgical emphysema

Answer

Tracheal incision is a transverse incision starting from the first tracheal ring

Answer

Performed under general anesthesia in infants

Question 5

What is correct about the fracture shown in the figure?

Accepted Answer

A= Bennett fracture, B= Rolando fracture

Answer

A= Rolando fracture, B= Bennett fracture

Answer

A= Boxer's fracture, B= Bennett fracture

Answer

A= Bennett fracture, B= Boxer's fracture

Question 6

The given nature of injury will lead to the development of:

Accepted Answer

Mallet finger

Answer

Jersey finger

Answer

Jammed finger

Answer

Boxer knuckle

Question 7

The contracture shown in the image is associated with all except:

Accepted Answer

Table top test is negative

Answer

Seen in cirrhosis

Answer

Involves the ring and little finger

Answer

Clostridial collagenase for resolution

Question 8

Comment on the diagnosis based on examination findings shown below: (Recent NEET Pattern 2016-17)

Accepted Answer

Volkmann ischemic contracture

Answer

Ulnar tunnel syndrome

Answer

Cubital tunnel syndrome

Answer

Wartenberg's syndrome

Question 9

A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Monteggia fracture

Answer

Colles fracture

Answer

Smith's fracture

Answer

Galeazzi's fracture

Question 10

The given X-ray of paranasal sinuses shows which view?

Accepted Answer

Waters' view

Answer

Caldwell view

Answer

Orthopantomogram

Answer

Luc's View

NEET-PG 2017

Anatomy

ENT

Orthopaedics

Radiology