ENT
2 questionsWhat causes the cart-wheel appearance of the tympanic membrane in acute suppurative otitis media (ASOM)?
Retraction of tympanic membrane touching the promontory. What is the classification according to Sade's grading system?
NEET-PG 2013 - ENT NEET-PG Practice Questions and MCQs
Question 491: What causes the cart-wheel appearance of the tympanic membrane in acute suppurative otitis media (ASOM)?
- A. Perforation of the tympanic membrane
- B. Edema of the tympanic membrane
- C. Congested blood vessels along the malleus (Correct Answer)
- D. Granulation tissue on the tympanic membrane
Explanation: ***Congested blood vessels along the malleus*** - The **cart-wheel appearance** in **acute suppurative otitis media (ASOM)** is a characteristic sign caused by the significant **engorgement of blood vessels** radiating out from the **malleus handle**. - This vascular congestion gives the tympanic membrane a distinct spoke-like pattern, resembling the spokes of a **cart wheel**. *Perforation of the tympanic membrane* - While **tympanic membrane perforation** can occur in ASOM, it typically signals a later stage of the disease, often leading to relief of pain and discharge, not the cart-wheel appearance. - Perforation appears as a **hole or defect** in the tympanic membrane, altering its integrity rather than its vascular pattern. *Edema of the tympanic membrane* - **Edema** (swelling) of the tympanic membrane does occur in ASOM due to inflammation, giving it a **dull, thickened, or bulging appearance**. - However, edema alone does not create the specific spoke-like pattern seen in the cart-wheel appearance; this pattern is primarily vascular. *Granulation tissue on the tympanic membrane* - **Granulation tissue** formation is more commonly associated with **chronic inflammatory processes** or healing after injury, and it would present as a **red, friable mass** on the tympanic membrane. - It is not a feature of early or established ASOM leading to the cart-wheel sign, which is an acute vascular phenomenon.
Question 492: Retraction of tympanic membrane touching the promontory. What is the classification according to Sade's grading system?
- A. Grade 1
- B. Grade 2
- C. Grade 3 (Correct Answer)
- D. Grade 4
Explanation: ***Grade 3*** - **Grade 3** retraction involves the tympanic membrane making contact with the **promontory** of the middle ear. - This contact indicates significant retraction, often with loss of definition of the malleus handle. *Grade 1* - **Grade 1** retraction is characterized by mild retraction with an **intact cone of light** and good mobility. - The tympanic membrane does not touch any middle ear structures. *Grade 2* - **Grade 2** retraction shows the tympanic membrane touching the **incudostapedial joint** or posterior wall of the middle ear. - The handle of the malleus may appear significantly foreshortened. *Grade 4* - **Grade 4** retraction involves **adhesive otitis media**, where the tympanic membrane is severely retracted and fully adherent to the middle ear structures. - This often results in a nearly complete obliteration of the middle ear space.
Microbiology
7 questionsWhich of the following conditions is NOT caused by Aspergillus?
Prions are best killed by
Which of the following is a cause of Valley fever (desert rheumatism)?
Which is not a DNA virus?
The fungus with septate hyphae and dichotomous branching is?
Cutaneous larva migrans is due to ?
Which of the following statements about Penicillium marneffei is incorrect?
NEET-PG 2013 - Microbiology NEET-PG Practice Questions and MCQs
Question 491: Which of the following conditions is NOT caused by Aspergillus?
- A. Otomycosis
- B. Dermatophytosis (Correct Answer)
- C. Allergic sinusitis
- D. Bronchopulmonary allergy
Explanation: ***Dermatophytosis*** - This condition is caused by **dermatophytes** (e.g., *Trichophyton*, *Microsporum*, *Epidermophyton*), which are a specific group of fungi that metabolize keratin. - *Aspergillus* species are generally **opportunistic molds** but do not typically cause dermatophytosis, which is a superficial fungal infection of the skin, hair, or nails. *Otomycosis* - **Otomycosis** is a fungal infection of the external ear canal, and *Aspergillus* species are a common cause, particularly *Aspergillus niger*. - It can lead to ear pain, discharge, itching, and hearing impairment. *Allergic sinusitis* - **Allergic fungal sinusitis (AFS)** is a common form of fungal sinusitis where *Aspergillus* species are significant contributors, often leading to a thick, tenacious allergic mucin. - This condition is an IgE-mediated hypersensitivity reaction to the fungal elements in the nasal and sinus cavities. *Bronchopulmonary allergy* - **Allergic bronchopulmonary aspergillosis (ABPA)** is a hypersensitivity reaction to *Aspergillus fumigatus* antigens that colonize the airways, particularly in individuals with asthma or cystic fibrosis. - It results in recurrent episodes of wheezing, cough, and transient pulmonary infiltrates, and can lead to bronchiectasis if left untreated.
Question 492: Prions are best killed by
- A. Incineration at high temperatures
- B. Autoclaving at 134°C (for 18 minutes) (Correct Answer)
- C. 5% formalin solution
- D. Sodium hypochlorite solution
Explanation: ***Autoclaving at 134°C (for 18 minutes)*** - **Prions** are highly resistant to conventional sterilization methods, and **autoclaving at 134°C for at least 18 minutes** is the **most effective method for sterilizing reusable medical instruments** contaminated with prions. - This high temperature and pressure protocol (WHO/CDC recommended) helps to denature the misfolded protein structure of prions, reducing their infectivity to safe levels. - **In the context of sterilization and disinfection**, this is the best practical method for surgical instruments that cannot be discarded. *Incineration at high temperatures* - **Incineration at 800-1000°C** achieves complete combustion and is **highly effective** at destroying prions. - However, incineration is used only for **single-use disposable items** and prion-contaminated waste, not for reusable surgical instruments. - In the clinical context of sterilization (implied by this topic), autoclaving is the preferred answer as it applies to reusable equipment. *Sodium hypochlorite solution* - **Sodium hypochlorite** (bleach) at **high concentrations** (20,000 ppm or 2% available chlorine) for extended contact times (1+ hours) can inactivate prions. - However, it is **corrosive to instruments**, damages tissue samples, and requires precise concentration and exposure conditions, making it less practical than autoclaving. *5% formalin solution* - Formalin is **not effective at inactivating prions**; it can actually **preserve and stabilize** prion infectivity. - Formalin cross-links proteins and preserves tissue morphology but does not reliably break down the highly stable **beta-sheet structures** characteristic of prions.
Question 493: Which of the following is a cause of Valley fever (desert rheumatism)?
- A. Sporothrix
- B. Cladosporium
- C. Phialophora
- D. Coccidioides (Correct Answer)
Explanation: ***Coccidioides*** - **Valley fever**, or desert rheumatism, is caused by infection with the dimorphic fungus **Coccidioides**, primarily **Coccidioides immitis** and **Coccidioides posadasii**. - This fungus is endemic to arid and semi-arid regions, especially the **southwestern United States** and parts of Central and South America. *Sporothrix* - **Sporothrix schenckii** causes sporotrichosis, a chronic fungal infection typically involving the skin, subcutaneous tissue, and adjacent lymphatics, often through skin trauma. - It does not cause Valley fever. *Cladosporium* - **Cladosporium** species are ubiquitous molds commonly found in outdoor and indoor environments, often associated with allergic reactions and occasionally superficial infections. - They are not a cause of Valley fever. *Phialophora* - **Phialophora** species are dematiaceous fungi that can cause phaeohyphomycosis, chromoblastomycosis, and eumycetoma, which are subcutaneous or systemic fungal infections. - They are not associated with Valley fever.
Question 494: Which is not a DNA virus?
- A. Rhabdovirus (Correct Answer)
- B. Poxvirus
- C. Papovavirus
- D. Parvovirus
Explanation: ***Rhabdovirus*** - Rhabdoviruses, such as the rabies virus, are characterized by their **single-stranded RNA genome** and distinctive bullet-shaped morphology. - They replicate in the cytoplasm of infected cells, using their **RNA-dependent RNA polymerase** to transcribe their genome. *Papovavirus* - Papovaviruses (now split into Papillomaviridae and Polyomaviridae) are **DNA viruses** known for causing warts and some cancers. - They possess a small, **double-stranded, circular DNA genome**. *Poxvirus* - Poxviruses are large, complex **DNA viruses** that replicate entirely within the cytoplasm of the host cell. - They have a **double-stranded DNA genome** and are notable for causing diseases like smallpox and molluscum contagiosum. *Parvovirus* - Parvoviruses are among the smallest viruses, characterized by their **single-stranded DNA genome**. - They require actively dividing host cells to replicate their **linear DNA**.
Question 495: The fungus with septate hyphae and dichotomous branching is?
- A. Aspergillus (Correct Answer)
- B. Penicillium
- C. Mucor
- D. Rhizopus
Explanation: ***Aspergillus*** - *Aspergillus* species are characterized by their **septate hyphae** and **acute-angle branching** (branching at approximately 45-degree angles), which are key distinguishing features in histopathology. - This branching pattern is sometimes referred to as "dichotomous branching" in medical literature, though true dichotomous branching is more characteristic of certain tissue forms. - This fungal morphology is often seen in infections such as **invasive aspergillosis** in immunocompromised patients. *Penicillium* - *Penicillium* also has **septate hyphae**, but its branching pattern is typically *not acute-angled or dichotomous*. - It is more commonly known for its **brush-like** conidiophores (penicillus) in culture rather than distinctive tissue branching patterns. *Mucor* - *Mucor* is a type of **zygomycete** (now classified under Mucorales) and is characterized by **aseptate or sparsely septate hyphae** with **irregular, right-angle branching**. - This is a key histological feature distinguishing it from *Aspergillus* in cases of **mucormycosis**. *Rhizopus* - Similar to *Mucor*, *Rhizopus* is also a zygomycete with **aseptate or sparsely septate hyphae** and **irregular, wide-angle branching**. - It is often identified in culture by the presence of **rhizoids** (root-like structures) and sporangiophores.
Question 496: Cutaneous larva migrans is due to ?
- A. W.bancrofti
- B. B. Malayi
- C. D. medinensis
- D. Ancylostoma braziliense (Correct Answer)
Explanation: ***Ancylostoma braziliense*** - **Cutaneous larva migrans** is primarily caused by the larvae of **dog and cat hookworms**, especially *Ancylostoma braziliense*. - Humans become **accidental hosts** when these larvae penetrate the skin but cannot complete their life cycle, leading to **serpiginous tracks**. *W. bancrofti* - This parasite, **Wuchereria bancrofti**, is a filarial nematode that causes **lymphatic filariasis** (elephantiasis). - Its effects are characterized by **lymphedema** and **hydrocele**, not migrating skin lesions. *B. Malayi* - **Brugia malayi** is another filarial nematode responsible for **lymphatic filariasis** in humans, similar to *W. bancrofti*. - It primarily causes **swelling of the limbs** and scrotum, not cutaneous larva migrans. *D. medinensis* - **Dracunculus medinensis** is the parasite that causes **dracunculiasis**, also known as **Guinea worm disease**. - This infection is characterized by a **painful blister** and subsequent emergence of the adult worm, which is distinct from creeping eruptions.
Question 497: Which of the following statements about Penicillium marneffei is incorrect?
- A. Forms black colonies (Correct Answer)
- B. Is a dimorphic fungus
- C. Amphotericin B is used for treatment
- D. Causes severe infections in immunocompromised patients
Explanation: ***Forms black colonies*** - *Penicillium marneffei* typically forms colonies that are often **reddish-beige** or **pigmented red-diffusible**, not black. - The production of a characteristic **red-to-burgundy pigment** is a key identifying feature of this fungus, especially in culture. *Is a dimorphic fungus* - This statement is correct. *Penicillium marneffei* is a **thermally dimorphic fungus**, meaning it grows as a mould at 25°C (room temperature) and as yeast-like cells at 37°C (body temperature). - This dimorphism is crucial for its pathogenesis and identification. *Amphotericin B is used for treatment* - This statement is correct. **Amphotericin B** is a commonly used antifungal agent for the treatment of severe *Penicillium marneffei* infections, particularly in immunocompromised patients. - It is often followed by a maintenance regimen with an azole antifungal like itraconazole. *Causes severe infections in immunocompromised patients* - This statement is correct. *Penicillium marneffei* is an **opportunistic pathogen** that primarily causes severe, disseminated infections in individuals with compromised immune systems, especially those with HIV/AIDS. - Endemic regions include Southeast Asia, where it is a leading cause of systemic mycosis in HIV-positive patients.
Pharmacology
1 questionsWhich of the following is a renin inhibitor?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 491: Which of the following is a renin inhibitor?
- A. Losartan
- B. Benazepril
- C. Remikiren (Correct Answer)
- D. Imidapril
Explanation: **Remikiren** - **Remikiren** is a direct **renin inhibitor** that acts by binding to the active site of renin, preventing its interaction with angiotensinogen. - This inhibition reduces the formation of **angiotensin I** and subsequently **angiotensin II**, leading to decreased blood pressure. *Losartan* - **Losartan** is an **Angiotensin II Receptor Blocker (ARB)**, meaning it blocks AT1 receptors, preventing angiotensin II from binding. - It does not inhibit renin activity directly but rather acts downstream in the **renin-angiotensin-aldosterone system (RAAS)**. *Benazepril* - **Benazepril** is an **Angiotensin-Converting Enzyme (ACE) inhibitor**, which blocks the enzyme responsible for converting **angiotensin I** to **angiotensin II**. - It does not directly inhibit renin production or activity. *Imidapril* - **Imidapril** is also an **Angiotensin-Converting Enzyme (ACE) inhibitor**, similar to benazepril. - Its mechanism of action involves inhibiting ACE, thereby reducing **angiotensin II** levels, rather than directly inhibiting renin.