FMGE 2023 - ENT PYQs Practice Questions

Q: 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?

Surgical excision. ***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. [Practice more ENT PYQs on OnCourse]

Q: Which of the following is true about laryngeal cancer stage T1bNOMO?

Both vocal cords involved, and mobile. ***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. [Practice more ENT PYQs on OnCourse]

Q: 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?

Vocal nodule. ***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. [Practice more ENT PYQs on OnCourse]

Q: 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?

Ramsay Hunt syndrome and geniculate ganglion. ***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 [Practice more ENT PYQs on OnCourse]

Q: 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?

Benign and invasive. ***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). [Practice more ENT PYQs on OnCourse]

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?

Accepted Answer

Surgical excision

Answer

Radiotherapy

Answer

FNAC

Answer

Needle biopsy

Question 2

Which of the following is true about laryngeal cancer stage T1bNOMO?

Accepted Answer

Both vocal cords involved, and mobile

Answer

Both vocal cords involved and fixed

Answer

One vocal cord involved and fixed

Answer

One vocal cord involved, and mobile

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?

Accepted Answer

Vocal nodule

Answer

Vocal polyp

Answer

Vocal cyst

Answer

Reinke's oedema

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?

Accepted Answer

Ramsay Hunt syndrome and geniculate ganglion

Answer

Ramsay Hunt syndrome and basal ganglion

Answer

Melkersson syndrome and otic ganglion

Answer

Melkersson syndrome and trigeminal ganglion

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?

Accepted Answer

Benign and invasive

Answer

Malignant and invasive

Answer

Benign and non-invasive

Answer

Malignant and 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?

Accepted Answer

Myringitis bullosa

Answer

Serous otitis media

Answer

Acute otitis media

Answer

Myringitis granulosa

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?

Accepted Answer

Hypertrophic rhinitis

Answer

Common cold

Answer

Nasal polyp

Answer

Atrophic rhinitis

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?

Accepted Answer

Glomus tumour

Answer

Chronic otitis media

Answer

Serous otitis media

Answer

Acute otitis media

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?

Accepted Answer

Esophagoscopy

Answer

Oxygen

Answer

Tracheostomy

Answer

Laryngoscopy

FMGE 2023 — ENT