NEET-PG 2023 Practice Questions

Q: During acute tonsillitis, referred pain from the tonsil to the middle ear occurs via which nerve?

Glossopharyngeal nerve. ***Glossopharyngeal nerve*** - The **glossopharyngeal nerve (CN IX)** provides sensory innervation to the palatine tonsil via its tonsillar branches - CN IX also supplies the middle ear via the **tympanic nerve (Jacobson's nerve)**, which forms the tympanic plexus - This shared sensory pathway explains **referred otalgia** (ear pain) during acute tonsillitis - Inflammation of the tonsil stimulates CN IX, and the brain misinterprets this as pain from the middle ear *Facial nerve* - The **facial nerve (CN VII)** primarily provides motor innervation to muscles of facial expression and taste to the anterior two-thirds of the tongue - While it has a small sensory component (nervus intermedius) for the external auditory canal, it does not innervate the tonsil - Cannot serve as the pathway for referred pain from tonsil to middle ear *Trigeminal nerve* - The **trigeminal nerve (CN V)** provides sensory innervation to the face, anterior scalp, and oral cavity - Does not innervate the palatine tonsil or the middle ear cavity - Not involved in tonsillar referred otalgia *Vagus nerve* - The **vagus nerve (CN X)** provides sensory innervation to parts of the pharynx, larynx, and external auditory canal (via Arnold's nerve) - While it contributes to pharyngeal sensation, the **glossopharyngeal nerve is the primary pathway** for referred otalgia from tonsillar inflammation due to its direct innervation of both the tonsil and middle ear

Q: Which of the following is true about nerve injuries?

Median nerve is also named as labourer's nerve. ***Median nerve is also named as labourer's nerve*** - The median nerve is sometimes called the "laborer's nerve" because it innervates many of the muscles essential for **fine motor control** and **dexterous hand movements** predominantly used in manual labor. [1] - It supplies most of the **flexors in the forearm** and several intrinsic hand muscles, making it crucial for a strong grip and coordinated hand actions. [1] *Froment sign seen in median nerve palsy is due to Flexor pollicis longus action* - **Froment's sign** is observed in **ulnar nerve palsy**, not median nerve palsy. - It occurs when the adductor pollicis is weak, and the **flexor pollicis longus** (median nerve-innervated) compensates by hyperflexing the interphalangeal joint of the thumb to grasp an object. *All lumbricals are supplied by median nerve* - The **first two lumbricals** (from the radial side) are typically supplied by the **median nerve**. [1] - The **third and fourth lumbricals** (from the ulnar side) are supplied by the **ulnar nerve**. [1] *Waenburg sign is seen in median nerve palsy* - There is no widely recognized clinical sign called "Waenburg sign" associated with median nerve palsy. - Common signs of **median nerve palsy** include **ape hand deformity**, **hand of benediction**, and sensory loss in the radial three and a half digits. [1]

Q: Enzyme activated by decrease in Insulin: glucagon ratio:

Glucose 6 phosphatase. ***Glucose 6 phosphatase*** - A decreased **insulin:glucagon ratio** signifies a catabolic state, promoting glucose release into the blood. - **Glucose-6-phosphatase** is the key enzyme in **gluconeogenesis** and **glycogenolysis** in the liver, dephosphorylating **glucose-6-phosphate** to **free glucose**, which can then be exported from the liver. *PFK* - **Phosphofructokinase (PFK)** is a key regulatory enzyme in **glycolysis**, which is inhibited in a state of low insulin:glucagon ratio. - Its activity would decrease, not increase, to reduce glucose utilization. *Glucokinase* - **Glucokinase** phosphorylates glucose to **glucose-6-phosphate** in the liver, trapping it for metabolism; its activity is increased by high insulin levels. - In a low insulin:glucagon ratio, its activity would be reduced to conserve glucose. *Hexokinase* - **Hexokinase** phosphorylates glucose in most peripheral tissues but has a lower Km for glucose than glucokinase, becoming saturated even at low glucose concentrations. - Its activity is not primarily regulated by the insulin:glucagon ratio; it is generally involved in glucose uptake for cellular energy needs.

Q: Method of autopsy in which organs of various systems are removed en masse:

Lettulle. ***Lettulle*** - The **Lettulle method** (or en masse method) involves the removal of organs in large blocks or as a single unit, which helps preserve anatomical relationships. - This technique is particularly useful for studying the **interrelationships between organs** and the spread of disease involving multiple systems. *Virchow* - The **Virchow method** involves the individual removal of each organ, which allows for detailed examination of each organ separately. - This method is straightforward but can disrupt the **anatomical relationships** between organs. *Rokitansky* - The **Rokitansky method** involves *in situ* dissection of organs, with the organs remaining largely in the body during dissection. - This technique is valued for maintaining the **topographical integrity** of organ systems within the body cavity. *Ghon* - The **Ghon method** is a modified block dissection method, focusing on the removal of specific organ blocks. - This often includes the **thoracic and abdominal organs** together, maintaining their anatomical connections.

Q: A 29-year-old patient presents with focal seizures. MRI shows frontal and temporal enhancement. What is the most probable diagnosis?

Herpes simplex encephalitis. ***Herpes simplex encephalitis*** - **Herpes simplex encephalitis (HSE)** characteristically causes inflammation and damage in the **frontal** and **temporal lobes**, leading to focal neurological deficits and seizures [1]. - MRI findings of **enhancement** in these specific brain regions are highly suggestive of HSE. *Enterovirus encephalitis* - **Enterovirus encephalitis** typically affects a broader range of brain regions and less commonly presents with the focal frontal and temporal enhancement seen in HSE. - While it can cause seizures, the MRI findings are not as specific for this diagnosis. *Japanese encephalitis* - **Japanese encephalitis** is geographically restricted to parts of Asia and is transmitted by mosquitoes. The clinical presentation typically includes diffuse encephalitic symptoms rather than focal frontal/temporal involvement and enhancement on MRI. - This diagnosis would be unlikely without a relevant travel history and exposure. *Meningococcal meningitis* - **Meningococcal meningitis** is an infection of the **meninges**, the membranes surrounding the brain and spinal cord, not primarily the brain tissue itself. - MRI would typically show inflammation and enhancement of the meninges, rather than focal parenchymal (brain tissue) enhancement in the frontal and temporal lobes.

Q: All of the following cause Fournier's gangrene except:

Clostridium. ***Clostridium*** - While *Clostridium* species (especially *C. perfringens*) **CAN be isolated** from Fournier's gangrene cases and contribute to gas formation and tissue necrosis, they are **less commonly identified as primary pathogens** compared to other organisms. - In the context of this question, *Clostridium* is considered the "except" option because it is **relatively less frequently implicated** in Fournier's gangrene compared to the other listed organisms, though it is NOT entirely excluded from the microbiology of this condition. - *Clostridium* species are more classically associated with **gas gangrene (clostridial myonecrosis)** in traumatic wounds and deep muscle tissue. *Bacteroides* - ***Bacteroides fragilis*** and other **anaerobic gram-negative bacilli** are among the **most commonly isolated organisms** in Fournier's gangrene. - They produce enzymes that facilitate tissue destruction and contribute significantly to the **polymicrobial synergistic necrotizing infection**. - Essential component of the typical microbial flora in perianal and genital infections. *Streptococcus* - ***Streptococcus pyogenes*** (Group A Streptococcus) and other streptococcal species are **frequently isolated** from Fournier's gangrene. - They produce toxins and enzymes causing **rapid necrotizing fasciitis** with systemic toxicity. - Major contributor to the aggressive nature and rapid progression of the infection. *Staphylococcus* - ***Staphylococcus aureus*** (including MRSA) is **commonly found** in polymicrobial Fournier's gangrene infections. - Contributes to local tissue destruction through toxin production and enzyme activity. - Often isolated from perianal and genital skin flora, facilitating its involvement in these infections.

Q: A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Acute Laryngotracheobronchitis. ***Acute Laryngotracheobronchitis*** - The combination of **low-grade fever** and **stridor** in a 2-year-old child strongly suggests **croup**, which is medically known as acute laryngotracheobronchitis. - Croup is characterized by **inflammation** of the larynx, trachea, and bronchi, often presenting with a **barking cough** and inspiratory stridor. The X-ray image would show the characteristic **steeple sign**. *Acute Bacterial Tracheitis* - This is a more severe bacterial infection that can present with stridor but typically shows **higher fever**, **toxic appearance**, and rapid clinical deterioration. - Unlike croup, bacterial tracheitis patients appear **more ill** and may have **purulent secretions** requiring more aggressive management. *Acute Epiglottitis* - A serious condition characterized by **rapid onset of high fever**, **dysphagia**, drooling, and a **"tripod" position**, which are not indicated by the given symptoms. - The stridor in epiglottitis is typically quieter and may indicate more severe airway obstruction compared to the characteristic stridor of croup. *Foreign Body aspiration* - While foreign body aspiration can cause stridor, it is typically an **acute event** with a sudden onset of choking, coughing, and respiratory distress. - There is no mention of a choking episode or sudden onset, and a low-grade fever is less typical for an uncomplicated foreign body aspiration.

Q: A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?

Pleomorphic adenoma. ***Pleomorphic adenoma*** - A **gradually progressive**, **painless mass** that has been present for 10 years, with a **firm to nodular** consistency and variability at different sites, is highly characteristic of a pleomorphic adenoma. - This benign tumor of salivary glands is known for its **slow growth** and **variable histological composition**, leading to its characteristic consistency. *Dermoid cyst* - Dermoid cysts are typically **present from birth** or early childhood and tend to be **soft and doughy** in consistency, rather than firm or nodular with variable consistency. - While painless, their growth pattern and texture differ from the described mass. *Malignancy* - A mass that has been present for **10 years** and is still described as **gradually progressive** but painless is less likely to be a malignancy, as most malignant tumors tend to grow more rapidly and often present with pain or other symptoms over such a long period. - Malignancies usually demonstrate a more infiltrative and aggressive growth pattern. *Sebaceous cyst* - A sebaceous cyst (epidermoid cyst) typically presents as a **smooth, movable, dome-shaped lump** and contains a cheesy, malodorous material, which is not consistent with a firm to nodular mass with varying consistency. - While they can be long-standing and painless, their characteristic feel and contents are different.

Q: A swelling behind the ear suggests fracture of:

Temporal bone. ***Temporal bone*** - Swelling behind the ear is a classic sign of **temporal bone fracture**, particularly involving the **mastoid portion**, which creates the characteristic **Battle's sign** (post-auricular ecchymosis and swelling). - Temporal bone fractures often accompany **basilar skull fractures** and may present with additional signs like **hemotympanum**, **CSF otorrhea**, or **facial nerve palsy**. *Orbital floor fracture* - **Orbital floor fractures** cause periorbital swelling, **diplopia** (especially on upward gaze), and **enophthalmos**, all localized to the **orbital region**. - These fractures do not involve structures behind the ear and would not cause **post-auricular swelling**. *Condylar fracture* - **Condylar fractures** typically cause **pre-auricular swelling** and pain, especially with jaw movement, as the condyle is located in front of the ear. - The swelling is anterior to the ear canal, not posterior, and is often accompanied by **trismus** and **malocclusion**. *Zygomatic complex* - **Zygomatic complex fractures** cause swelling and ecchymosis around the **cheekbone** and lateral orbital rim, not behind the ear. - These fractures may also cause **infraorbital numbness** due to infraorbital nerve involvement and **trismus** from coronoid process impingement.

Q: When resuscitating a patient in shock which of the following is not an adequate parameter to predict end point of resuscitation?

Blood pressure. ***Blood pressure*** - While essential for initial assessment and guiding treatment, **blood pressure** can be maintained within normal limits even in significant shock states due to compensatory mechanisms [1]. - Blood pressure alone does not reflect **tissue perfusion** or cellular oxygenation, which are the true endpoints of resuscitation [1]. *Mixed venous oxygen saturation* - **Mixed venous oxygen saturation (SvO2)** reflects the balance between oxygen delivery and consumption, providing insight into global tissue oxygenation. - A low SvO2 indicates inadequate oxygen delivery relative to demand, making it a valuable target for guiding resuscitation. *Base deficit* - **Base deficit** is a measure of metabolic acidosis and reflects the severity of tissue hypoperfusion and anaerobic metabolism. - Normalization of base deficit indicates correction of metabolic derangements and improved tissue perfusion. *Lactate* - **Lactate** is a product of anaerobic metabolism, which occurs when tissues are not adequately perfused or oxygenated. - Elevated lactate levels indicate tissue hypoperfusion, and serial measurements are crucial for monitoring the effectiveness of resuscitation and predicting outcomes.

Question 1

During acute tonsillitis, referred pain from the tonsil to the middle ear occurs via which nerve?

Accepted Answer

Glossopharyngeal nerve

Answer

Facial nerve

Answer

Trigeminal nerve

Answer

Vagus nerve

Question 2

Which of the following is true about nerve injuries?

Accepted Answer

Median nerve is also named as labourer's nerve

Answer

Froment sign seen in median nerve palsy is due to Flexor pollicis longus action

Answer

All lumbricals are supplied by median nerve

Answer

Waenburg sign is seen in median nerve palsy

Question 3

Enzyme activated by decrease in Insulin: glucagon ratio:

Accepted Answer

Glucose 6 phosphatase

Answer

PFK

Answer

Glucokinase

Answer

Hexokinase

Question 4

Method of autopsy in which organs of various systems are removed en masse:

Accepted Answer

Lettulle

Answer

Virchow

Answer

Rokitansky

Answer

Ghon

Question 5

A 29-year-old patient presents with focal seizures. MRI shows frontal and temporal enhancement. What is the most probable diagnosis?

Accepted Answer

Herpes simplex encephalitis

Answer

Enterovirus encephalitis

Answer

Japanese encephalitis

Answer

Meningococcal meningitis

Question 6

All of the following cause Fournier's gangrene except:

Accepted Answer

Clostridium

Answer

Bacteroides

Answer

Streptococcus

Answer

Staphylococcus

Question 7

A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Accepted Answer

Acute Laryngotracheobronchitis

Answer

Acute Bacterial Tracheitis

Answer

Acute Epiglottitis

Answer

Foreign Body aspiration

Question 8

A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?

Accepted Answer

Pleomorphic adenoma

Answer

Dermoid cyst

Answer

Malignancy

Answer

Sebaceous cyst

Question 9

A swelling behind the ear suggests fracture of:

Accepted Answer

Temporal bone

Answer

Zygomatic complex

Answer

Condylar fracture

Answer

Orbital floor fracture

Question 10

When resuscitating a patient in shock which of the following is not an adequate parameter to predict end point of resuscitation?

Accepted Answer

Blood pressure

Answer

Mixed venous oxygen saturation

Answer

Base deficit

Answer

Lactate

NEET-PG 2023

Anatomy

Biochemistry

Forensic Medicine

Internal Medicine

Microbiology

Pediatrics

Surgery