Question 1

Q: A 60-year-old male presents with painless cervical lymphadenopathy. On examination, the right ear reveals conductive hearing loss with a dull tympanic membrane. Moreover, decreased mobility of the soft palate was also noted. What is the probable diagnosis?

Nasopharyngeal carcinoma. ***Nasopharyngeal carcinoma*** - This presentation with **painless cervical lymphadenopathy**, **conductive hearing loss** due to Eustachian tube obstruction, and **cranial nerve involvement** (affecting the soft palate mobility) is highly suggestive of nasopharyngeal carcinoma, which often metastasizes early. - The conductive hearing loss, specifically a **dull tympanic membrane**, points to **otitis media with effusion** secondary to Eustachian tube dysfunction, a common presentation of nasopharyngeal masses obstructing the tube. *Adenoid cystic cancer* - While adenoid cystic carcinoma can cause cranial nerve palsies due to **perineural invasion**, it more commonly arises in the salivary glands and not typically presents with nasopharyngeal masses causing Eustachian tube obstruction. - It usually presents with a **palpable mass** or **pain**, which is not the primary presentation here. *Juvenile nasopharyngeal angiofibroma* - This is a **benign vascular tumor** typically presenting in **adolescent males** with episodes of **severe epistaxis** and **nasal obstruction**. - It does not commonly present with cervical lymphadenopathy or cranial nerve involvement and is rare in a 60-year-old. *Quinsy* - Quinsy, or **peritonsillar abscess**, presents acutely with **severe sore throat**, **fever**, **trismus**, and sometimes **uvular deviation**. - It is an **infectious condition** and does not typically cause painless cervical lymphadenopathy or conductive hearing loss as described. [Practice more ENT PYQs on OnCourse]

Question

A 60-year-old male presents with painless cervical lymphadenopathy. On examination, the right ear reveals conductive hearing loss with a dull tympanic membrane. Moreover, decreased mobility of the soft palate was also noted. What is the probable diagnosis?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Adenoid cystic cancer

Answer

Juvenile nasopharyngeal angiofibroma

Answer

Quinsy

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