Anatomy
1 questionsPtosis in Horner syndrome is due to the involvement of which muscle?
NEET-PG 2024 - Anatomy NEET-PG Practice Questions and MCQs
Question 261: Ptosis in Horner syndrome is due to the involvement of which muscle?
- A. Müller muscle (Correct Answer)
- B. Levator aponeurosis
- C. Horner's muscle
- D. Orbicularis oculi
Explanation: ***Müller muscle*** - **Ptosis** in **Horner syndrome** results from the paralysis of the **smooth muscle fibers** of the Müller muscle (also known as the superior tarsal muscle), which is innervated by the **sympathetic nervous system**. - This muscle contributes a small amount to upper eyelid elevation, and its denervation causes a **mild unilateral ptosis**. *Levator aponeurosis* - The **levator aponeurosis** is involved in eyelid elevation but is primarily innervated by the **oculomotor nerve (III cranial nerve)**, not the sympathetic system. - Damage to the oculomotor nerve or the aponeurosis itself would cause a more **severe ptosis** than seen in Horner syndrome. *Horner's muscle* - **Horner's muscle**, also known as the **lacrimal part of the orbicularis oculi muscle**, is involved in the drainage of tears, not eyelid elevation. - It does not play a role in the ptosis associated with **Horner syndrome**. *Orbicularis oculi* - The **orbicularis oculi muscle** is responsible for **eyelid closure** and is innervated by the **facial nerve (VII cranial nerve)**. - Its dysfunction would lead to difficulty closing the eye, not ptosis or an inability to open it.
ENT
2 questionsWhich sinus drainage is impaired in the following image?
A female patient's pure tone audiometry (PTA) findings show the presence of a Carhart's notch. Which of the following specific clinical signs can be seen in this patient?
NEET-PG 2024 - ENT NEET-PG Practice Questions and MCQs
Question 261: Which sinus drainage is impaired in the following image?
- A. Ethmoid
- B. Sphenoid
- C. Frontal
- D. Maxillary (Correct Answer)
Explanation: ***Maxillary*** - The image shows **arrows pointing to the maxillary sinuses** with visible **opacification and fluid accumulation**, indicating **impaired drainage**. - Maxillary sinuses drain through the **ostiomeatal complex** into the middle meatus; obstruction leads to mucus retention and sinusitis. *Ethmoid* - The **ethmoid air cells** located between the eyes, medial to the orbits, do not show significant **opacification** or drainage impairment. - These complex honeycomb-like structures appear **relatively clear** without evidence of fluid accumulation. *Sphenoid* - The **sphenoid sinuses** located deeper in the skull, behind the ethmoid sinuses, are **not prominently affected** in this image. - No significant **opacification** or mucosal thickening visible to suggest impaired drainage. *Frontal* - The **frontal sinuses** located above the eyebrows appear **relatively clear** without significant opacification or drainage impairment. - These sinuses drain through the **frontonasal duct** and do not show evidence of fluid retention in this image.
Question 262: A female patient's pure tone audiometry (PTA) findings show the presence of a Carhart's notch. Which of the following specific clinical signs can be seen in this patient?
- A. Schwartz sign (Correct Answer)
- B. Hitselberger sign
- C. Hennebert sign
- D. Rinne test negative (conductive hearing loss)
Explanation: ***Schwartz sign*** - A **Carhart's notch** (bone conduction dip at 2000 Hz) is a characteristic finding in **otosclerosis**, a condition where the stapes bone becomes fixed. - The **Schwartz sign** (reddish/pinkish hue behind the tympanic membrane) indicates **active otosclerosis** with increased vascularity in the promontory. - This is a **specific clinical sign** directly associated with otosclerosis and would be the expected finding on otoscopy. *Hitselberger sign* - The **Hitselberger sign** refers to **hypesthesia** (numbness or decreased sensation) in the **posterior external auditory canal wall**. - It is associated with **acoustic neuromas** (vestibular schwannomas) due to compression of the facial nerve, not otosclerosis. *Hennebert sign* - The **Hennebert sign** involves **nystagmus or vertigo** induced by changes in external ear canal pressure (fistula test). - It is typically seen in conditions causing a **perilymphatic fistula**, such as **Meniere's disease** or **syphilitic labyrinthitis**, not otosclerosis. *Rinne test negative (conductive hearing loss)* - While otosclerosis does cause **conductive hearing loss** with a negative Rinne test (bone conduction > air conduction), this is a **general audiometric finding**, not a specific clinical sign. - A negative Rinne test can occur in **any cause of conductive hearing loss** (chronic otitis media, ossicular discontinuity, cholesteatoma, etc.). - The question asks for a **specific clinical sign**, making the **Schwartz sign** the most appropriate answer as it specifically indicates otosclerosis.
Ophthalmology
6 questionsIdentify the visual field defect shown in the image.
A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?
What is the diagnosis if a patient can only see 3 green dots on the Worth 4 Dot test?
A patient presents to the OPD with the finding shown in the image. What is the most likely diagnosis?
A patient, three years post-surgery, presents with the condition shown in the image and complains of decreased vision. What is the most likely diagnosis?
Identify the diagnosis based on the clinical image shown.
NEET-PG 2024 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 261: Identify the visual field defect shown in the image.
- A. Binasal hemianopia
- B. Bitemporal hemianopia (Correct Answer)
- C. Homonymous hemianopia
- D. Altitudinal defect
Explanation: ***Bitemporal hemianopia*** - The image shows loss of vision in the **temporal (outer) halves of both visual fields**, which is characteristic of bitemporal hemianopia. - This defect typically results from a lesion at the **optic chiasm**, compressing the crossing nasal retinal fibers, often due to a **pituitary tumor**. *Binasal hemianopia* - This condition involves visual loss in the **nasal (inner) halves of both visual fields**, which is the opposite of what is depicted. - It is a rare defect that can be caused by lesions affecting the **uncrossed temporal retinal fibers** on both sides, such as from bilateral carotid artery aneurysms. *Homonymous hemianopia* - A homonymous hemianopia involves the **same half of the visual field in both eyes** (e.g., right visual field loss in both eyes), resulting from a lesion posterior to the optic chiasm. - The image clearly shows different halves affected in each eye (temporal fields), not the same half. *Altitudinal defect* - An altitudinal defect involves the **loss of vision in the upper or lower half of the visual field** in one or both eyes, respecting the horizontal midline. - The visual field loss shown in the image is vertical, affecting the temporal halves, not the upper or lower halves.
Question 262: A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?
- A. Retinitis pigmentosa (Correct Answer)
- B. Retinal hemorrhage
- C. Fundus albipunctatus
- D. Fundus flavimaculatus
Explanation: ***Retinitis pigmentosa*** - The fundoscopic image exhibits **bone spicule-like pigment deposits** in the periphery, **attenuation of retinal vessels**, and a **waxy pallor of the optic disc**, which are characteristic signs of retinitis pigmentosa. The clinical presentation of gradual loss in **night vision (nyctalopia)** and **peripheral vision** (tunnel vision) is classic for this inherited retinal dystrophy, as it primarily affects the **rod photoreceptors** first. *Retinal hemorrhage* - Retinal hemorrhages appear as **red blotches or streaks** on the fundus and are usually associated with conditions like **hypertension**, **diabetes**, or **retinal vein occlusion**. This image does not show acute red hemorrhages, but rather **dark, aggregated pigment**, and the symptoms do not align with sudden vision changes often seen in acute hemorrhages. *Fundus albipunctatus* - This condition is characterized by numerous **small, discrete, white or yellowish dots** scattered throughout the retina, usually sparing the macula. While it can cause night blindness, the fundoscopic image here shows **bone spicule pigmentation** and **vascular attenuation**, not the widespread white dots typical of fundus albipunctatus. *Fundus flavimaculatus* - This refers to Stargardt disease or fundus flavimaculatus, which presents with **yellowish flecks** (pisiform or fish-tail shaped) scattered in the posterior pole and mid-periphery, along with **macular degeneration**. The image does not show these distinct yellow flecks or evident macular changes, and the pigmentary changes are more consistent with retinitis pigmentosa.
Question 263: What is the diagnosis if a patient can only see 3 green dots on the Worth 4 Dot test?
- A. Right eye suppression (Correct Answer)
- B. Crossed diplopia
- C. Uncrossed diplopia
- D. Left eye suppression
Explanation: ***Right eye suppression*** - Seeing **three green dots** exclusively indicates that the patient is only perceiving input from the **left eye**. - In the Worth 4 Dot test, the **left eye** (viewing through a green filter) sees **three green dots**: the white dot at the top (which appears green through the filter) plus the two lateral green dots. - The **right eye** (viewing through a red filter) normally sees **two red dots**: the white dot at the top (which appears red) plus the red dot at the bottom. - Since the patient sees only **three green dots**, the visual input from the **right eye is being suppressed**. *Crossed diplopia* - **Crossed diplopia** (heteronymous diplopia) occurs when the image from the right eye is perceived to the left of the image from the left eye. - This typically occurs with **exotropia** (divergent strabismus) and would result in seeing **five or more dots** (patient perceives both eyes' images but misaligned), not just three green. *Uncrossed diplopia* - **Uncrossed diplopia** (homonymous diplopia) occurs when the image from the right eye is perceived to the right of the image from the left eye. - This is usually associated with **esotropia** (convergent strabismus) and would also lead to the perception of **five or more dots** (both eyes' images perceived but misaligned), not only three green dots. *Left eye suppression* - If there were **left eye suppression**, the patient would see **two red dots** from the right eye only (the white dot appearing red plus the red dot at the bottom). - Seeing **three green dots** confirms the **left eye input is dominant** and the **right eye is suppressed**.
Question 264: A patient presents to the OPD with the finding shown in the image. What is the most likely diagnosis?
- A. Limbal dermoid (Correct Answer)
- B. Pyogenic granuloma
- C. Papilloma
- D. Pinguecula
Explanation: ***Limbal dermoid*** - A **limbal dermoid** is a congenital benign tumor typically found at the **limbus**, the junction between the cornea and sclera. - It appears as a **raised, yellowish-white mass** and may contain elements like hair follicles or sebaceous glands. *Pyogenic granuloma* - A **pyogenic granuloma** is a rapidly growing, benign vascular lesion that typically occurs after trauma or surgery. - It presents as a **red, pedunculated nodule** that bleeds easily, unlike the described finding. *Papilloma* - **Papillomas** are benign epithelial tumors caused by the human papillomavirus (HPV). - They appear as **small, fleshy growths** with a cauliflower-like surface and are less common at the limbus. *Pinguecula* - A **pinguecula** is a common, benign yellowish growth on the conjunctiva, usually located on the nasal side of the cornea. - It does not typically involve the **cornea** or appear as a raised mass like a dermoid tumor.
Question 265: A patient, three years post-surgery, presents with the condition shown in the image and complains of decreased vision. What is the most likely diagnosis?
- A. Corneal Dystrophy
- B. Posterior Subcapsular Cataract (PSC)
- C. Pseudophakic Bullous Keratopathy
- D. Posterior Capsular Opacification (Correct Answer)
Explanation: ***Posterior Capsular Opacification*** - The image (especially part B, the **red reflex view**) shows a cloudy membrane with **Elschnig pearls** and fibrous tissue behind the intraocular lens, which is characteristic of **PCO**. - PCO commonly occurs months to years after cataract surgery and causes **decreased vision** due to scattering of light. *Corneal Dystrophy* - Corneal dystrophies primarily affect the **cornea**, leading to various forms of corneal opacification, and would typically appear as cloudiness or irregularities within the corneal layers. - While it can cause decreased vision, the opacification seen in the image is clearly behind the iris plane and involves the posterior capsule, not the cornea. *Pseudophakic Bullous Keratopathy* - This condition involves **corneal edema** and **bullae formation** due to endothelial cell dysfunction, leading to a hazy cornea. - The image does not show corneal edema or bullae; instead, the primary pathology is located at the **posterior capsule** of the intraocular lens. *Posterior Subcapsular Cataract (PSC)* - A PSC is a type of cataract that forms **before cataract surgery** and affects the natural crystalline lens. - The patient is three years post-surgery, indicating that the natural lens has been replaced, making a PSC (of the natural lens) an impossible diagnosis in this context.
Question 266: Identify the diagnosis based on the clinical image shown.
- A. Horner-Trantas spots
- B. Herbert's pits (Correct Answer)
- C. Pannus
- D. Corneal dystrophy
Explanation: ***Herbert's pits*** - The image displays characteristic **pits at the limbus**, which are a hallmark of healed follicular conjunctivitis, specifically **Herbert's pits**. - These pits are pathognomonic for **trachoma**, a chronic keratoconjunctivitis caused by *Chlamydia trachomatis*. *Horner-Trantas spots* - These are small, raised, gelatinous white dots found at the limbus, typically containing **eosinophils**. - They are characteristic of **vernal keratoconjunctivitis**, an allergic inflammatory condition, and not seen in the provided image. *Pannus* - **Pannus** refers to the growth of **vascularized connective tissue** onto the cornea. - While pannus is also a feature of trachoma, the image specifically shows distinct limbal pits, rather than diffuse vascularization. *Corneal dystrophy* - **Corneal dystrophies** are a group of inherited, bilateral, and progressive corneal disorders that manifest as opacities or structural changes in the cornea. - The findings in the image, such as pits, are inflammatory in origin and distinct from the typically stromal or epithelial changes seen in corneal dystrophies.
Pediatrics
1 questionsA 2 -month-old child presents with the following condition as shown in the image. What is the ideal management protocol?
NEET-PG 2024 - Pediatrics NEET-PG Practice Questions and MCQs
Question 261: A 2 -month-old child presents with the following condition as shown in the image. What is the ideal management protocol?
- A. Operate immediately
- B. Surgery after 6 months of age
- C. Surgery after 2 years of age
- D. Medical management (Correct Answer)
- E. Refer to pediatric ophthalmology for evaluation
Explanation: ***Medical management*** - The image shows **epicanthal folds**, which are normal in many Asian infants and children. They are **congenital, benign skin folds** that cover the inner corner of the eye. - In a 2-month-old child, these folds are a normal variant and typically **recede with age**. No medical intervention, surgical or otherwise, is usually required. *Operate immediately* - **No medical indication** for immediate surgery as epicanthal folds are not a pathological condition requiring urgent correction. - Surgical intervention for cosmetic purposes is typically considered much later in life, if at all, when facial features are more developed. *Surgery after 6 months of age* - Epicanthal folds are **still a normal finding** in infants up to 6 months of age and often persist for several years. - Premature surgical correction could be unnecessary as the folds may resolve naturally with the development of the **nasal bridge**. *Surgery after 2 years of age* - While epicanthal folds can still be present at 2 years of age, surgery is **rarely indicated** unless they cause significant vision problems (e.g., pseudostrabismus) or severe cosmetic concerns that persist into later childhood. - By this age, many children will have developed a more prominent nasal bridge, which can lessen the appearance of the folds naturally. *Refer to pediatric ophthalmology for evaluation* - While specialist referral might be considered if there are concerns about **vision impairment or true strabismus**, isolated epicanthal folds in a 2-month-old infant are a **normal anatomical variant** that does not require specialist evaluation. - Referral would be appropriate only if there were functional concerns beyond the cosmetic appearance of the folds.