A 16-year-old boy presented with recurrent epistaxis. There is no history of trauma associated with it. On examination, there is a firm purplish mass on the left posterior choanae. Which of the following is the most appropriate for managing this patient?
Which of the following is true about laryngeal cancer stage T1bNOMO?
A patient who is a teacher by profession presents to the clinic with hoarseness of voice. What is the most likely diagnosis for this patient?
A patient presents with painful vesicles in the external auditory meatus and over the tympanic membrane. In addition to that, he also has facial nerve palsy. What is the most likely diagnosis and which is the site that is affected?
A patient presented with unilateral nasal obstruction associated with watery nasal discharge and bleeding. A diagnosis of inverted papilloma is made. Which of the following is true about this condition?
A 5-year-old child presents with sudden severe ear pain and hearing loss. On otoscopy, you observe hemorrhagic bullae on an inflamed tympanic membrane. What is the most likely diagnosis?
A patient presents with a thick nasal discharge and headache. Examination reveals hypertrophy of the inferior turbinate with a mulberry appearance. Which of the following is the most likely diagnosis?
A 35-year-old woman presented to the clinic with the symptoms of hearing loss and pulsatile tinnitus. Further examination reveals conductive hearing loss with the Rinne test negative. A reddish mass is seen behind the tympanic membrane. What is the most likely diagnosis for this patient?
A 2-year-old child was brought to the emergency department. The child was having difficulty in speaking and breathing. An X-ray was performed, given below. Which among the following is the best treatment for this condition?
FMGE 2023 - ENT FMGE Practice Questions and MCQs
Question 1: A 16-year-old boy presented with recurrent epistaxis. There is no history of trauma associated with it. On examination, there is a firm purplish mass on the left posterior choanae. Which of the following is the most appropriate for managing this patient?
- A. Surgical excision (Correct Answer)
- B. Radiotherapy
- C. FNAC
- D. Needle biopsy
Explanation: ***Surgical excision***- The presentation (adolescent male, recurrent epistaxis, purplish posterior choanal mass) is classic for **Juvenile Nasopharyngeal Angiofibroma (JNA)**, a highly vascular, benign tumor.- **Surgical excision** is the definitive treatment for JNA, which is usually preceded by preoperative **embolization** to dramatically reduce the risk of severe intraoperative hemorrhage.*Needle biopsy*- Performing any blind or needle biopsy in suspected JNA is strictly **contraindicated** due to the high risk of severe, uncontrolled hemorrhage.- Diagnosis relies primarily on **clinical features** and characteristic findings on imaging (CT/MRI), which delineate the tumor's extent and vascular supply.*FNAC*- Similar to a core or punch biopsy, **FNAC (Fine Needle Aspiration Cytology)** is contraindicated due to the tumor's characteristic lack of a capillary system and abundance of large, thin-walled vessels.- This highly vascular nature means even minimal trauma can lead to profuse and life-threatening **bleeding** which can be difficult to manage. *Radiotherapy*- **Radiotherapy** is generally reserved for large, inoperable, recurrent, or residual tumors, particularly those with significant intracranial extension.- It is considered a secondary modality and is avoided as primary treatment for localized JNA due to associated risks of long-term morbidities such as **secondary malignancies** or **pituitary dysfunction** in adolescents.
Question 2: Which of the following is true about laryngeal cancer stage T1bNOMO?
- A. Both vocal cords involved and fixed
- B. Both vocal cords involved, and mobile (Correct Answer)
- C. One vocal cord involved and fixed
- D. One vocal cord involved, and mobile
Explanation: ***Both vocal cords involved, and mobile***- The **T1** designation in glottic laryngeal cancer implies that the tumor is strictly limited to the **vocal cords** and that mobility is preserved (i.e., they are **mobile**).- The subsequent **T1b** substage defines tumors that involve **both vocal cords** (e.g., crossing the anterior or posterior commissure) while maintaining normal movement.*Both vocal cords involved and fixed*- **Vocal cord fixation** is a defining feature of **T3** glottic carcinoma, indicating deep invasion into the paralaryngeal space or underlying musculature.- This designation immediately excludes **T1** staging, which strictly requires preserved vocal cord **mobility**.*One vocal cord involved and fixed*- **Fixation** (immobility) places the tumor in **T3** or higher, regardless of tumor size or involvement of one versus both vocal cords.- **T1a** is defined by involvement of only **one vocal cord**, but critically, it must be mobile to be classified as T1.*One vocal cord involved, and mobile*- This specific description corresponds to **T1a** glottic laryngeal cancer, which involves the tumor being confined to the **glottis** and limited to only **one vocal cord**, with normal mobility.
Question 3: A patient who is a teacher by profession presents to the clinic with hoarseness of voice. What is the most likely diagnosis for this patient?
- A. Vocal polyp
- B. Vocal cyst
- C. Reinke's oedema
- D. Vocal nodule (Correct Answer)
Explanation: ***Vocal nodules***- This is the most likely diagnosis as **vocal nodules** (or singer's nodules) are typically caused by chronic **vocal strain** and **misuse**, common in professions like teaching.- Nodules present as bilateral, symmetrical lesions at the junction of the anterior one-third and posterior two-thirds of the vocal cords, leading to persistent **hoarseness**.*Vocal polyp*- Usually presents as a **unilateral** mass and is often caused by a single acute instance of **vocal trauma** (e.g., screaming) or long-term irritants like smoking.- While causing hoarseness, polyps are less commonly associated with the chronic, bilateral lesions seen from professional voice abuse compared to nodules.*Vocal cyst*- These are retention cysts or epidermoid cysts, which are usually **unilateral** and are not primarily linked to the pathogenesis of professional voice overuse, although they can cause persistent hoarseness.- Cysts are formed when a mucus gland duct is blocked or when keratin builds up, and they are typically located sub-epithelially, appearing deeper than nodules.*Reinke's oedema*- This condition is almost exclusively associated with **heavy smoking** and is characterized by a gelatinous, bilateral swelling of the superficial lamina propria (*Reinke's space*).- While it causes severe hoarseness, the primary predisposing factor (smoking) is absent in the prompt, making nodules (vocal abuse) a more probable primary diagnosis based on the profession.
Question 4: A patient presents with painful vesicles in the external auditory meatus and over the tympanic membrane. In addition to that, he also has facial nerve palsy. What is the most likely diagnosis and which is the site that is affected?
- A. Ramsay Hunt syndrome and basal ganglion
- B. Ramsay Hunt syndrome and geniculate ganglion (Correct Answer)
- C. Melkersson syndrome and otic ganglion
- D. Melkersson syndrome and trigeminal ganglion
Explanation: ***Ramsay Hunt syndrome and geniculate ganglion*** - **Ramsay Hunt syndrome (herpes zoster oticus)** is caused by reactivation of varicella-zoster virus (VZV) in the **geniculate ganglion** of the facial nerve (CN VII) - **Classic triad:** Otalgia with vesicular eruption in the ear canal/tympanic membrane, ipsilateral facial nerve palsy, and auditory/vestibular symptoms - The **geniculate ganglion** is located at the genu (bend) of the facial nerve in the temporal bone and contains sensory neurons; VZV reactivation here causes the characteristic vesicular rash in the ear and facial paralysis - **Treatment:** High-dose antivirals (acyclovir/valacyclovir) plus corticosteroids within 72 hours, with eye protection if incomplete eyelid closure *Incorrect: Ramsay Hunt syndrome and basal ganglion* - While the diagnosis of Ramsay Hunt syndrome is correct based on the clinical presentation, the **basal ganglion** is incorrect - Basal ganglia are deep brain nuclei involved in motor control (caudate, putamen, globus pallidus), not sites of VZV reactivation or facial nerve involvement *Incorrect: Melkersson syndrome and otic ganglion* - **Melkersson-Rosenthal syndrome** presents with the triad of recurrent facial edema, relapsing facial palsy, and fissured tongue (lingua plicata) - It does **NOT** present with painful vesicular eruptions, which is the key distinguishing feature in this case - The **otic ganglion** is a parasympathetic ganglion associated with CN IX (glossopharyngeal nerve), not CN VII *Incorrect: Melkersson syndrome and trigeminal ganglion* - Melkersson-Rosenthal syndrome does not cause vesicular rash - The **trigeminal ganglion** (Gasserian ganglion) contains cell bodies of CN V sensory neurons; VZV reactivation here causes herpes zoster ophthalmicus, not Ramsay Hunt syndrome - Facial nerve palsy is not a feature of trigeminal nerve involvement
Question 5: A patient presented with unilateral nasal obstruction associated with watery nasal discharge and bleeding. A diagnosis of inverted papilloma is made. Which of the following is true about this condition?
- A. Malignant and invasive
- B. Benign and non-invasive
- C. Malignant and non-invasive
- D. Benign and invasive (Correct Answer)
Explanation: ***Benign and invasive*** Inverted papilloma (Schneiderian papilloma) is a **benign epithelial tumor** that characteristically exhibits **locally invasive behavior**, making option D correct. **Key features of inverted papilloma:** - **Benign histology** but behaves aggressively - **Locally invasive** - grows into underlying stroma and can erode bone - Unilateral presentation (cardinal feature) - Origin from lateral nasal wall/maxillary sinus - High recurrence rate (10-30%) if incompletely excised - **Malignant transformation risk: 5-15%** (usually to squamous cell carcinoma) - Requires complete surgical excision with wide margins **Clinical presentation (as in this case):** - Unilateral nasal obstruction (most common) - Epistaxis (bleeding) - Watery rhinorrhea - Fullness/mass sensation *Incorrect: Malignant and invasive* While inverted papilloma is invasive, it is histologically benign, not malignant. However, surveillance is needed due to malignant transformation potential. *Incorrect: Benign and non-invasive* Though benign, inverted papilloma is NOT non-invasive. Its locally aggressive behavior with invasion into adjacent structures distinguishes it from simple benign polyps. *Incorrect: Malignant and non-invasive* This option is incorrect on both counts - inverted papilloma is benign (not malignant) and invasive (not non-invasive).
Question 6: A 5-year-old child presents with sudden severe ear pain and hearing loss. On otoscopy, you observe hemorrhagic bullae on an inflamed tympanic membrane. What is the most likely diagnosis?
- A. Myringitis bullosa (Correct Answer)
- B. Serous otitis media
- C. Acute otitis media
- D. Myringitis granulosa
Explanation: ***Myringitis bullosa*** - This diagnosis is strongly suggested by the otoscopic image showing **hemorrhagic or serous bullae (blisters)** on an inflamed tympanic membrane, which is the pathognomonic feature of this condition. - It is an acute inflammation of the tympanic membrane, often associated with viral or bacterial infections (e.g., **Mycoplasma pneumoniae**, Influenza virus), and typically presents with sudden, severe otalgia and hearing loss. *Serous otitis media* - This condition, also known as otitis media with effusion, is characterized by the presence of fluid in the middle ear space, leading to a **dull, retracted tympanic membrane** with visible **air-fluid levels or bubbles**, not bullae on the surface. - It typically presents with conductive hearing loss and a feeling of fullness in the ear, but lacks the severe inflammation and bullae seen in the image. *Acute otitis media* - The classic sign of acute otitis media is a **bulging, erythematous, and opaque tympanic membrane** due to purulent effusion in the middle ear, with loss of normal landmarks. - While bullae can occasionally form in severe cases of AOM, the primary feature is the bulging eardrum, and the prominent, multiple vesicles seen here are more specific to myringitis bullosa. *Myringitis granulosa* - This is a chronic inflammatory condition characterized by the presence of **granulation tissue** on the lateral surface of the tympanic membrane. - It typically presents with persistent otorrhea and conductive hearing loss, and the otoscopic appearance is of a raw, granular surface, which is distinctly different from the fluid-filled bullae shown in the image.
Question 7: A patient presents with a thick nasal discharge and headache. Examination reveals hypertrophy of the inferior turbinate with a mulberry appearance. Which of the following is the most likely diagnosis?
- A. Common cold
- B. Hypertrophic rhinitis (Correct Answer)
- C. Nasal polyp
- D. Atrophic rhinitis
Explanation: ***Hypertrophic rhinitis***- This is a form of **chronic rhinitis** where persistent inflammation leads to irreversible changes, including mucosal and sub-mucosal fibrosis and hypertrophy.- The inferior turbinate hypertrophy becomes nodular, leading to the characteristic irreversible **"mulberry appearance"** on examination, correlating with thick discharge and obstruction.*Atrophic rhinitis*- This condition involves **atrophy** (shrinking) of the nasal mucosa and associated turbinates, leading to wide nasal passages, crusting, and often a foul smell (**ozena**).- The examination would show diminished turbinate size and a patent nasal cavity, which contradicts the finding of turbinate hypertrophy.*Common cold*- While causing discharge and headache, the discharge is typically watery (**rhinorrhea**) initially, progressing to mucoid, and the illness is acute and self-limiting.- It does not cause permanent or marked **fibrotic hypertrophy** of the inferior turbinates with a mulberry appearance, which is a sign of chronic inflammation.*Nasal polyp*- Nasal polyps are pale, glistening, freely mobile, non-tender masses that typically resemble **peeled grapes** and usually arise from the middle meatus.- Polyps represent edematous mucosa and are distinct from the fixed, hyperplastic tissue constituting the hypertrophied inferior turbinate itself.
Question 8: A 35-year-old woman presented to the clinic with the symptoms of hearing loss and pulsatile tinnitus. Further examination reveals conductive hearing loss with the Rinne test negative. A reddish mass is seen behind the tympanic membrane. What is the most likely diagnosis for this patient?
- A. Chronic otitis media
- B. Glomus tumour (Correct Answer)
- C. Serous otitis media
- D. Acute otitis media
Explanation: ***Glomus tumour (Correct Answer)*** - **Pulsatile tinnitus** combined with **conductive hearing loss** and a **reddish retrotympanic mass** forms the classic diagnostic triad for glomus tympanicum (a paraganglioma arising from glomus bodies). - The **reddish vascular mass** behind the tympanic membrane is pathognomonic, sometimes called the **'rising sun sign'** or demonstrating **Brown's sign** (blanching with pneumatic otoscopy). - This slow-growing, highly vascular tumor characteristically presents with these features in middle-aged adults. *Acute otitis media (Incorrect)* - This acute bacterial infection presents with rapid onset of **otalgia** (ear pain), **fever**, and a bulging, intensely red tympanic membrane. - While it causes temporary conductive hearing loss due to **purulent fluid** accumulation, it lacks the chronic presentation and **pulsatile tinnitus** characteristic of vascular masses. - The clinical course is acute (days), not chronic like glomus tumors. *Chronic otitis media (Incorrect)* - Defined by chronic inflammation typically resulting in **tympanic membrane perforation**, recurrent **otorrhea** (ear discharge), and possible **cholesteatoma** formation. - While it causes conductive hearing loss, it does **not** produce **pulsatile tinnitus** or a **reddish, vascular retrotympanic mass**. - The tympanic membrane shows perforation or scarring, not an intact membrane with a vascular mass behind it. *Serous otitis media (Incorrect)* - Also known as **otitis media with effusion**, involves sterile, non-purulent fluid in the middle ear from **eustachian tube dysfunction**. - The tympanic membrane appears dull, retracted, or shows **air-fluid levels** and bubbles, but does not show a vascular mass. - This condition does **not** cause **pulsatile tinnitus** and the fluid is serous, not vascular tissue.
Question 9: A 2-year-old child was brought to the emergency department. The child was having difficulty in speaking and breathing. An X-ray was performed, given below. Which among the following is the best treatment for this condition?
- A. Esophagoscopy (Correct Answer)
- B. Oxygen
- C. Tracheostomy
- D. Laryngoscopy
Explanation: ***Esophagoscopy*** - The flat, circular appearance of the coin on an AP X-ray is characteristic of a foreign body in the **esophagus** (coins in the trachea appear sagittal/linear on AP view). - An **esophageal foreign body** can compress the trachea from behind, causing respiratory distress, especially in young children with a narrow airway. - **Esophagoscopy** is the definitive treatment for removing esophageal foreign bodies and will relieve both the mechanical obstruction and the tracheal compression causing respiratory symptoms. - This should be performed urgently in a child with respiratory compromise, with anesthesia support ready to secure the airway if needed. *Tracheostomy* - A **tracheostomy** would be indicated for direct **tracheal or laryngeal obstruction** that cannot be relieved by other means. - However, in this case, the foreign body is in the **esophagus** (not the trachea), and the respiratory distress is due to external compression of the trachea. - Performing a tracheostomy would not remove the foreign body and is unnecessarily invasive when the definitive treatment (esophagoscopy) can address both the obstruction and the symptoms. *Laryngoscopy* - A **laryngoscopy** is used to visualize the larynx and can remove foreign bodies at or above the vocal cords. - The X-ray findings indicate an **esophageal** foreign body, not a laryngeal one, making laryngoscopy inappropriate for definitive management. *Oxygen* - Supplemental **oxygen** is an important supportive measure to improve oxygen saturation in any patient with respiratory distress. - However, it does not address the underlying mechanical problem (the esophageal foreign body compressing the trachea) and is not definitive treatment.