NEET-PG 2017 Practice Questions

Q: Which of the following test is being performed on the patient?

Dix-Hallpike test. ***Dix-Hallpike test*** - The image depicts a patient being moved from an upright sitting position to a supine position with the head turned to one side and extended, which is characteristic of the **Dix-Hallpike maneuver**. - This test is used to diagnose **benign paroxysmal positional vertigo (BPPV)** by provoking vertigo and nystagmus as a result of otoconia displacement in the semicircular canals. *Caloric stimulation test* - This test involves introducing **warm or cold water/air into the ear canal** to induce nystagmus, assessing the vestibular system. - It's typically performed with the patient lying supine with their head elevated at 30 degrees, not involving the specific positional changes shown in the image. *Doll's eye reflex* - Also known as the **oculocephalic reflex**, it assesses brainstem function by rapidly turning the patient's head while observing eye movement. - This reflex is primarily used to evaluate comatose patients and does not involve the complex body and head positioning seen in the image. *Frenzel maneuver* - The Frenzel maneuver is performed during **otoscopy** to check for nystagmus by having the patient gaze through high plus lenses in a dark room. - It is often used to suppress visual fixation and enhance nystagmus, but it does not involve the specific body or head movements depicted.

Q: The test shown in the image is used for identifying a lesion in which cranial nerve?

VII. ***VII*** - The image shows a **Schirmer's test** being conducted, which measures **tear production**. - Tear production is primarily innervated by the **facial nerve (cranial nerve VII)**, making this test relevant for evaluating its function related to lacrimation. *III* - Cranial nerve III (oculomotor nerve) controls most **extraocular muscles**, pupillary constriction, and lid elevation. A lesion would manifest as issues with eye movement, ptosis, or pupil dilation, not tear production. - The Schirmer's test does not directly assess the function of the **oculomotor nerve**. *VI* - Cranial nerve VI (abducens nerve) innervates the **lateral rectus muscle**, responsible for abducting the eye (moving it outwards). - A lesion in CN VI would cause **diplopia** and inability to move the eye laterally, which is unrelated to tear production. *VIII* - Cranial nerve VIII (vestibulocochlear nerve) is responsible for **hearing** and **balance**. - Lesions affect hearing (e.g., deafness, tinnitus) or balance (e.g., vertigo, nystagmus), and have no direct involvement in tear production.

Q: MRI Brain of a 40-year-old patient with progressive unilateral SNHL and tinnitus is shown below. Which is the most common extracanalicular nerve to be involved?

V. ***V*** - The image shows a large **right cerebellopontine angle (CPA) mass**, consistent with an **acoustic neuroma** (vestibular schwannoma), which commonly arises from CN VIII in the internal auditory canal and extends into the CPA. - The **trigeminal nerve (CN V)** is the most common extracanalicular cranial nerve to be compressed and involved by larger CPA tumors due to its proximity and superior-anterior position relative to CN VIII. *VI* - The abducens nerve (CN VI) controls the lateral rectus muscle of the eye, and its involvement typically causes **diplopia** and **lateral gaze palsy**. While possible with very large and medially extending CPA tumors, it is less common than CN V involvement. - CN VI is located more medially and anteriorly within the brainstem and generally requires significant mass effect rather than direct compression from a typical CPA tumor. *VII* - The facial nerve (CN VII) travels with the vestibulocochlear nerve (CN VIII) through the **internal auditory canal**, and is frequently involved by acoustic neuromas within the canal, leading to **facial weakness or paralysis**. - However, the question specifically asks for the most common **extracanalicular** nerve involvement. While CN VII is intimately associated, its most common site of involvement is within the canal, or early in the CPA, and V is often implicated with larger CPA masses. *VIII* - The vestibulocochlear nerve (CN VIII) is the nerve from which **acoustic neuromas (vestibular schwannomas)** originate, causing the presenting symptoms of **unilateral SNHL and tinnitus**. Therefore, it is the primary affected nerve, not an extracanalicular one involved due to compression. - The question asks for the most common **extracanalicular nerve to be involved**, implying a nerve *other than* the one the tumor originates from or primarily affects locally within the canal.

Q: A 40-year-old woman presents with history of recurrent episodes of spinning sensation in horizontal direction with vertigo incapacitating her for hours and resolving with medication. She also report roaring tinnitus during the attacks. Her sequential audiogram done on 11.06.16 and 18.06.16 is given below. Diagnosis is:

Meniere's disease. ### ***Meniere's disease*** - This patient presents with the classic triad of **Meniere's disease**: recurrent **vertigo**, **roaring tinnitus**, and fluctuating **sensorineural hearing loss** (as shown by the sequential audiograms with improvement). - The audiogram demonstrates **fluctuating hearing loss**, which is typical for Meniere's, with the hearing loss being worse on June 11th and improving by June 18th, particularly at lower frequencies (a pattern often seen in Meniere's). ### *Migraine variant* - While migraine can cause vertigo (**vestibular migraine**), it typically does not present with characteristic **roaring tinnitus** or **fluctuating hearing loss** on audiometry. - The audiogram showing a clear pattern of fluctuating sensorineural hearing loss points away from an isolated migraine variant. ### *Benign paroxysmal positional vertigo* - BPPV causes **brief episodes of vertigo** triggered by specific head movements, usually lasting seconds to a minute, and is not associated with roaring tinnitus or hearing loss. - The patient's vertigo episodes are described as "incapacitating her for hours," which is inconsistent with the short duration of BPPV attacks. ### *Acoustic neuroma* - An acoustic neuroma typically causes **progressive, unilateral sensorineural hearing loss**, persistent tinnitus (often high-pitched), and sometimes imbalance, but **recurrent, sudden, severe vertigo** and **fluctuating hearing** are less common. - The rapid fluctuation and improvement in hearing shown on the sequential audiograms are not characteristic of the generally slow, progressive nature of hearing loss due to an acoustic neuroma.

Q: The instrument shown below is used in ENT for all except: (Recent NEET Pattern 2016-17)

Oculovestibular reflex. ***Oculovestibular reflex*** - The image shows a **tympanometer**, which is used to assess the function of the middle ear and Eustachian tube through **impedance audiometry**. - The **oculovestibular reflex** (also known as the **caloric reflex test**) assesses the function of the vestibular system and brainstem using cold or warm water/air irrigation of the ear canal, and is **not evaluated by tympanometry**. - This is the correct answer as it is the only function NOT assessed by the tympanometer. *Status of middle ear* - Tympanometry directly measures the **compliance of the tympanic membrane** and the **pressure in the middle ear space**, providing information about middle ear pathologies. - It can help diagnose conditions like **otitis media with effusion**, **eustachian tube dysfunction**, and **otosclerosis** by analyzing the tympanogram shape (Type A, B, C, etc.). *Status of tympanic membrane* - Tympanometry measures how the **tympanic membrane moves in response to changes in air pressure** in the external ear canal. - This movement pattern, depicted in the tympanogram, indicates the **flexibility and integrity of the tympanic membrane**. *Acoustic reflex* - The **acoustic reflex (stapedial reflex)** CAN be measured using **impedance audiometry**, which includes the tympanometer. - When a loud sound (70-100 dB above hearing threshold) is presented, the stapedius muscle contracts, causing a change in middle ear impedance that is detected by the tympanometer. - This reflex tests the integrity of the **auditory pathway from CN VIII through the brainstem to CN VII**, and is useful in diagnosing conditions like **acoustic neuroma**, **facial nerve palsy**, and **cochlear vs retrocochlear pathology**.

Q: Cosmetic reconstruction of this defect is best done at? (Recent NEET Pattern 2016-17)

6-10 years. ***6-10 years of age*** - Ear reconstruction for **microtia**, as seen in the image, is typically recommended between 6 and 10 years of age. This allows for sufficient growth of the **contralateral ear** to serve as a template and for the child's **rib cartilage** to be large enough for grafting. - At this age, children are also better able to **cooperate** with the multi-stage surgical process and are old enough to understand the procedure, which is crucial for emotional well-being.

Q: The facial features shown in the image are characteristic of:

Adenoid facies. ***Adenoid facies*** - The image displays characteristic features of adenoid facies, including a **long, open-mouthed face**, a **pinched nose**, and possibly a **high-arched palate** due to chronic mouth breathing from enlarged adenoids. - This chronic condition often leads to a dull expression, sometimes with **strabismus** (crossed eyes) as seen in the image, and a forward head posture. *Frog face deformity* - This deformity is characterized by **ocular hypertelorism** (widely spaced eyes), a **flat nasal bridge**, and a **short nose**, often associated with conditions like Apert syndrome. - While there is some facial dysmorphology, the specific combination of features does not align with a typical frog face. *Ashen grey facies* - This refers to a **pale, grayish complexion**, often indicative of severe cardiovascular compromise like **circulatory collapse** or **shock**. - The child in the image has a normal skin tone for their ethnicity and does not show signs of acute circulatory distress. *Thyrotoxicosis* - **Thyrotoxicosis** (hyperthyroidism) in children can cause symptoms like **exophthalmos** (bulging eyes), **tachycardia**, weight loss, and an enlarged thyroid gland. - While the child's eyes appear wide-set and sometimes strabismic, these are more consistent with the long-term effects of chronic mouth breathing on facial development rather than acute thyroid dysfunction.

Q: The image shows which of the following tests being performed? (Recent NEET Pattern 2016-17)

A= Indirect laryngoscopy, B= Spatula test. ***A= Indirect laryngoscopy, B= Spatula test*** - Image A depicts a mirror being used to visualize the larynx through the oral cavity, which is characteristic of **indirect laryngoscopy**. - Image B shows a spatula being used to apply pressure to the tongue or jaw while observing for a reflex action, which is consistent with the **spatula test** for tetanus. *A= Posterior rhinoscopy, B= Spatula test* - **Posterior rhinoscopy** involves visualizing the nasopharynx via a mirror placed behind the soft palate, which is not what is shown in Image A. - While Image B correctly shows a spatula test, Image A is clearly not a posterior rhinoscopy. *A= Direct laryngoscopy, B= Spatula test* - **Direct laryngoscopy** uses a laryngoscope to directly visualize the larynx without a mirror, often requiring sedation, which differs from the technique in Image A. - Image A shows the use of a mirror for visualization, thus ruling out direct laryngoscopy. *A= Anterior rhinoscopy, B= Spatula test* - **Anterior rhinoscopy** involves examining the anterior nasal cavity using a nasal speculum, which is not depicted in Image A. - Image A shows examination of the oral cavity and pharynx with a mirror, not the anterior nasal cavity.

Question 1

Which of the following test is being performed on the patient?

Accepted Answer

Dix-Hallpike test

Answer

Caloric stimulation test

Answer

Doll's eye reflex

Answer

Frenzel maneuver

Question 2

The test shown in the image is used for identifying a lesion in which cranial nerve?

Accepted Answer

VII

Answer

III

Answer

VI

Answer

VIII

Question 3

MRI Brain of a 40-year-old patient with progressive unilateral SNHL and tinnitus is shown below. Which is the most common extracanalicular nerve to be involved?

Accepted Answer

V

Answer

VI

Answer

VII

Answer

VIII

Question 4

A 40-year-old woman presents with history of recurrent episodes of spinning sensation in horizontal direction with vertigo incapacitating her for hours and resolving with medication. She also report roaring tinnitus during the attacks. Her sequential audiogram done on 11.06.16 and 18.06.16 is given below. Diagnosis is:

Accepted Answer

Meniere's disease

Answer

Migraine variant

Answer

Benign paroxysmal positional vertigo

Answer

Acoustic neuroma

Question 5

The instrument shown below is used in ENT for all except: (Recent NEET Pattern 2016-17)

Accepted Answer

Oculovestibular reflex

Answer

Status of middle ear

Answer

Status of tympanic membrane

Answer

Acoustic reflex

Question 6

Cosmetic reconstruction of this defect is best done at? (Recent NEET Pattern 2016-17)

Accepted Answer

6-10 years

Answer

Birth to 2 years

Answer

3-5 years

Answer

After 12 years

Question 7

All of the following statements regarding this instrument are true except: (Recent NEET Pattern 2016-17)

Accepted Answer

This device is used to administer antibiotics in the middle ear cavity

Answer

Speculum that is used here has a concave lens with a magnification of 2.5 times

Answer

This device is used to assess tympanic membrane mobility

Answer

This device is used to suck out middle ear secretions

Question 8

The facial features shown in the image are characteristic of:

Accepted Answer

Adenoid facies

Answer

Frog face deformity

Answer

Ashen grey facies

Answer

Thyrotoxicosis

Question 9

The volume of the balloons shown in epistaxis balloon is: (Recent NEET Pattern 2016-17)

Accepted Answer

72. (d)

Answer

73. (b)

Answer

74. (b)

Answer

75. (c)

Question 10

The image shows which of the following tests being performed? (Recent NEET Pattern 2016-17)

Accepted Answer

A= Indirect laryngoscopy, B= Spatula test

Answer

A= Posterior rhinoscopy, B= Spatula test

Answer

A= Direct laryngoscopy, B= Spatula test

Answer

A= Anterior rhinoscopy, B= Spatula test