A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?
A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?
A patient presents to the OPD with hearing loss. On examination: - Rinne test - Positive in the left ear and negative in the right ear - Weber's test - lateralization towards the left - Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.
Identify the treatment option with the image given below:
A patient presented to the OPD with complaints of greenish black matter in the nose with foul-smelling discharge. What is the diagnosis?
A patient presents with a fish bone stuck in the pyriform sinus. During the removal procedure, there is accidental nerve injury. Which nerve is most likely to be damaged?
Human papillomavirus (HPV) infection is most strongly associated with which of the following head and neck cancers?
The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?
A patient presents with a history of fall and is found to have bleeding from the ear on examination. What is the investigation of choice?
A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?
FMGE 2025 - ENT FMGE Practice Questions and MCQs
Question 1: A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?
- A. Ethmoidal sinus
- B. Frontal sinus
- C. Maxillary sinus (Correct Answer)
- D. Sphenoidal sinus
Explanation: ***Maxillary sinus*** - The coronal CT scan clearly shows opacification (fluid collection) in the right **maxillary sinus**, the large air-filled space located inferior to the orbit and lateral to the nasal cavity. - Nasal polyps commonly arise in the **middle meatus**, which is the primary drainage site for the maxillary sinus via the **maxillary ostium**. Obstruction here leads to fluid retention and sinusitis. *Ethmoidal sinus* - The **ethmoidal sinuses** are a complex of small air cells located between the orbits. While some mild mucosal thickening may be present, they are not the site of the large, complete fluid collection seen in the image. - These sinuses also drain into the **middle meatus** (anterior and middle ethmoidal cells) and **superior meatus** (posterior ethmoidal cells), but the primary pathology shown is not within the ethmoid air cells themselves. *Sphenoidal sinus* - The **sphenoidal sinus** is located more posteriorly within the sphenoid bone, behind the ethmoid sinuses, and is not the sinus shown to be opacified in this anterior coronal view. - It drains into the **sphenoethmoidal recess**, a location superior and posterior to the superior turbinate, anatomically distinct from the area affected by the polyp. *Frontal sinus* - The **frontal sinuses** are situated superior to the orbits within the frontal bone. The image shows these sinuses are well-aerated and free of significant fluid. - Drainage of the frontal sinus occurs via the **frontonasal duct** into the **middle meatus**. Obstruction would cause fluid buildup superior to the eye, which is not seen here.
Question 2: A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?
- A. Grommet insertion + Steroids
- B. Steroids
- C. Radiotherapy (Correct Answer)
- D. Grommet insertion
Explanation: ***Correct: Radiotherapy*** - This clinical presentation is **classic for nasopharyngeal carcinoma (NPC)**: middle-aged patient from **Nagaland** (endemic region for NPC in Northeast India), unilateral serous otitis media (dull TM, hearing loss, tinnitus from Eustachian tube obstruction), and **posterior triangle lymphadenopathy** (most characteristic feature) - **NPC is highly radiosensitive** and radiotherapy is the primary treatment modality for all stages - Concurrent chemoradiotherapy is the standard for locally advanced disease - The geographic origin (Nagaland) is a critical clue as NPC has high incidence in Northeast India, Southeast Asia, and Southern China (associated with EBV infection and dietary factors) *Incorrect: Grommet insertion + Steroids* - Treats only the **secondary middle ear effusion**, not the underlying malignancy - Would delay definitive diagnosis and treatment of NPC - May temporarily relieve hearing symptoms but doesn't address the cancer *Incorrect: Steroids* - No role in the treatment of nasopharyngeal carcinoma - May mask symptoms and delay diagnosis - Does not address the underlying malignancy or lymphadenopathy *Incorrect: Grommet insertion* - Only addresses the **symptomatic serous otitis media**, not the primary pathology - The presence of posterior triangle lymph nodes makes malignancy the priority - Any adult with unilateral serous otitis media + cervical lymphadenopathy requires nasopharyngoscopy and biopsy to rule out NPC before symptomatic treatment
Question 3: A patient presents to the OPD with hearing loss. On examination: - Rinne test - Positive in the left ear and negative in the right ear - Weber's test - lateralization towards the left - Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.
- A. Conductive hearing loss in left ear
- B. Conductive hearing loss in right ear
- C. Sensorineural hearing loss in right ear (Correct Answer)
- D. Sensorineural hearing loss in left ear
Explanation: ***Sensorineural hearing loss in right ear***- The **Weber test** lateralizes toward the **left ear**, which acts as the better ear. In cases of **unilateral sensorineural hearing loss (SNHL)**, sound lateralizes to the *unaffected* ear.- The **Bone Conduction (BC)** hearing is explicitly reported as **reduced in the right ear**, which is the definitive finding for damage to the **cochlea** or **auditory nerve** (SNHL).*Sensorineural hearing loss in left ear*- If SNHL was present in the left ear, the **Weber test** would lateralize to the *right ear* (the better ear), contradicting the finding of lateralization to the left.- The Rinne test is **positive** in the left ear (AC > BC), and BC is similar to normal, confirming that the left ear is functioning normally or has only mild SNHL.*Conductive hearing loss in left ear*- A **positive Rinne test** in the left ear (AC > BC) essentially rules out significant **conductive hearing loss (CHL)** in that ear, as CHL results in a negative Rinne test (BC > AC).- While Weber lateralization to the left is consistent with CHL in the left ear, the simultaneous positive Rinne test and normal BC assessment contradict this diagnosis.*Conductive hearing loss in right ear.*- Although the **Rinne test is negative** in the right ear (BC > AC), suggesting CHL, the **Weber test lateralizes to the left**; Weber lateralizes to the *affected* ear only in CHL.- Furthermore, **Bone Conduction is reduced** in the right ear, which is inconsistent with simple CHL, where BC is expected to be normal (or elevated due to masking).
Question 4: Identify the treatment option with the image given below:
- A. Type 3 tympanoplasty (Correct Answer)
- B. Type 2 tympanoplasty
- C. Type 4 tympanoplasty
- D. Type 1 tympanoplasty
Explanation: ***Type 3 tympanoplasty*** - This procedure, also known as **myringostapediopexy**, involves placing a graft directly onto the head of the stapes, as depicted in the image. - It is indicated when both the **malleus** and **incus** are eroded or absent, but the stapes is intact and mobile, allowing for sound transmission directly to the stapes. *Type 1 Tympanoplasty* - This is a simple repair of a tympanic membrane perforation, also called **myringoplasty**, where the graft is placed to close the hole. - This procedure is only suitable when the **ossicular chain** is completely intact and mobile, which is not the case shown. *Type 2 tympanoplasty* - This is performed when the **malleus** is eroded, and the graft is placed onto the **incus** or the remaining part of the malleus. - The image shows that the incus is also absent, as the graft is placed directly on the stapes, making this option incorrect. *Type 4 tympanoplasty* - This procedure is indicated when only the **stapes footplate** remains and is mobile; the graft is placed directly on the footplate. - This creates a very shallow middle ear space, essentially shielding only the round window and Eustachian tube opening, a more extensive reconstruction than shown.
Question 5: A patient presented to the OPD with complaints of greenish black matter in the nose with foul-smelling discharge. What is the diagnosis?
- A. Rhinitis caseosa
- B. Allergic rhinitis
- C. Atrophic rhinitis (Correct Answer)
- D. Rhinitis sicca
Explanation: ***Atrophic rhinitis***- This condition is characterized by progressive atrophy of the nasal mucosa and underlying turbinate bones, leading to excessively wide nasal cavities.- The presence of large, dry, **greenish-black crusts** that produce a very offensive, sickening smell (**ozena**) is the classic defining feature, matching the patient's presentation.*Allergic rhinitis*- This condition presents with symptoms like watery rhinorrhea, sneezing, nasal itching, and **conjunctivitis**, often triggered by specific allergens.- It is an inflammatory condition and does not result in the mucosal atrophy or the formation of large, fetid, **greenish-black crusts** (ozena).*Rhinitis caseosa*- This rare form is characterized by the accumulation of a firm, malodorous, **cheese-like** (caseous) material that acts as a foreign body within the nasal cavity, differentiating it from the general crusting of atrophic rhinitis.- While it causes a very foul smell, the material retrieved is typically described as caseous or putty-like, not the widespread greenish-black crusts typical of ozena.*Rhinitis sicca*- This condition involves localized **dryness** and minor crusting, often restricted to the anterior nasal septum, typically seen in dry climates or specific occupations.- It is characterized by persistent dryness and discomfort but generally lacks the severe **mucosal atrophy** or the intense, offensive odor (**ozena**) associated with generalized greenish-black crusts found in atrophic rhinitis.
Question 6: A patient presents with a fish bone stuck in the pyriform sinus. During the removal procedure, there is accidental nerve injury. Which nerve is most likely to be damaged?
- A. Internal branch of the superior laryngeal nerve (Correct Answer)
- B. Recurrent laryngeal nerve
- C. Glossopharyngeal nerve
- D. External branch of the superior laryngeal nerve
Explanation: ***Internal branch of the superior laryngeal nerve***- This nerve branch runs immediately beneath the **mucosa** of the pyriform sinus before piercing the thyrohyoid membrane, making it highly susceptible to injury during instrumentation or foreign body manipulation in this area.- It is the principal **sensory nerve** supply to the laryngeal cavity above the vocal cords; injury would result in loss of sensation in this region, often leading to laryngeal incompetence and aspiration.*Recurrent laryngeal nerve*- This nerve is located more inferiorly within the **tracheoesophageal groove**, supplying motor innervation to nearly all intrinsic muscles of the larynx.- Injury to the recurrent laryngeal nerve would cause **vocal cord paralysis** and hoarseness, which is less likely given the specific location of minimal trauma in the high hypopharynx.*Glossopharyngeal nerve*- The glossopharyngeal nerve (**CN IX**) supplies sensation to the posterior third of the tongue, tonsils, and **oropharynx**, and is not directly related to the pyriform sinus mucosa.- Injury would primarily manifest as loss of the **gag reflex** and sensory deficits in the posterior pharynx, which is topographically distant from the immediate site of endoscopic manipulation in the hypopharynx.*External branch of the superior laryngeal nerve*- This nerve primarily provides **motor innervation** to the **cricothyroid muscle**, responsible for lengthening and tensing the vocal cords (pitch control).- Anatomically, it descends alongside the **superior thyroid artery** and is situated deeper and more anteriorly, placing it at less risk of superficial mucosal trauma than the internal branch.
Question 7: Human papillomavirus (HPV) infection is most strongly associated with which of the following head and neck cancers?
- A. Laryngeal carcinoma
- B. Hypopharyngeal carcinoma
- C. Oropharyngeal carcinoma (Correct Answer)
- D. Nasopharyngeal carcinoma
Explanation: ***Oropharyngeal carcinoma***- HPV (high-risk types, especially **HPV-16**) is the primary etiologic agent for a distinct and increasing subtype of **oropharyngeal squamous cell carcinoma (OPSCC)**, mainly affecting the tonsils and base of the tongue.- HPV-positive OPCs are biologically distinct from those caused by tobacco and alcohol, typically present in younger patients, and have a significantly improved prognosis.*Nasopharyngeal carcinoma*- The strongest viral association with nasopharyngeal carcinoma (NPC) is the **Epstein-Barr virus (EBV)**, not HPV.- NPC is also strongly linked to dietary factors (salted fish) and genetic predisposition, often showing a different geographic distribution.*Hypopharyngeal carcinoma*- This cancer is predominantly caused by heavy use of tobacco and alcohol, placing it firmly in the category of traditional **squamous cell carcinoma** risk factors.- HPV positivity in hypopharyngeal cancers is rare and not considered a major causative factor.*Laryngeal carcinoma*- Laryngeal squamous cell carcinoma is overwhelmingly associated with **tobacco smoking** and, secondarily, alcohol use.- While HPV can cause laryngeal papillomatosis, its definitive causal role in invasive laryngeal *carcinoma* is weak and inconsistent compared to its strong association with the oropharynx.
Question 8: The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?
- A. Zygomatic abscess
- B. Bezold's abscess
- C. Citelli’s abscess
- D. Luc's abscess (Correct Answer)
Explanation: ***Luc's abscess*** - This is a **subperiosteal abscess** located in the **preauricular region**, on the external surface of the squamous part of the temporal bone, which corresponds to the highlighted area. - It is a rare complication of **acute otitis media** or **mastoiditis**, occurring when infection spreads through the tympanosquamous suture. *Citelli’s abscess* - This abscess is located at the **tip of the mastoid process** and extends into the **digastric triangle** of the neck, which is posterior and inferior to the area shown. - It is formed when pus from mastoiditis tracks along the posterior belly of the **digastric muscle**. *Bezold's abscess* - This is a **deep neck abscess** that forms when infection erodes through the medial aspect of the mastoid tip and spreads inferiorly into the neck. - The swelling is located deep to the **sternocleidomastoid muscle**, far from the preauricular location shown in the image. *Zygomatic abscess* - This abscess forms over the **zygomatic process** of the temporal bone, which is located superior and anterior to the external auditory canal. - It results from the spread of infection from mastoid air cells into the **root of the zygoma**, a location slightly more superior than what is highlighted.
Question 9: A patient presents with a history of fall and is found to have bleeding from the ear on examination. What is the investigation of choice?
- A. X-ray Skull
- B. MRI Brain
- C. CBC
- D. CT Temporal bone (Correct Answer)
Explanation: ***CT Temporal bone***- This is the **investigation of choice** for suspected **temporal bone fractures**, which are strongly suggested by **otorrhagia** (bleeding from the ear) following trauma.- CT provides superior resolution for visualizing the intricate bony anatomy of the temporal bone, allowing for the precise identification of fracture line extension (e.g., *longitudinal* or *transverse*) and related complications like **ossicular chain integrity** or **hemotympanum**.*CBC*- Complete Blood Count (CBC) is part of the initial trauma workup to assess general systemic status (e.g., potential **blood loss** or baseline hemoglobin), but it is not a diagnostic tool for identifying the source of bleeding (the anatomical injury).- It provides no structural information necessary to localize the injury or determine the presence of a **skull fracture**.*MRI Brain*- **MRI** is optimized for visualizing **soft tissue injury** (e.g., brain contusions, nerve damage) and is poor for detailing acute bony fractures, especially the fine structures of the temporal bone.- It may be used if profound neurological deficits or specific **intracranial injury** (e.g., vascular dissection or brain parenchymal damage) are suspected, but not as the primary diagnostic imaging for bony trauma.*X-ray Skull*- **Plain X-rays** lack the sensitivity and detail required to reliably capture the subtle, complex fractures of the **temporal bone** or skull base.- This method is largely superseded by **CT scans** for trauma evaluation due to high rates of **false negatives** regarding skull base injuries.
Question 10: A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?
- A. Meniere’s disease
- B. Presbycusis (Correct Answer)
- C. Otosclerosis
- D. Acoustic neuroma
Explanation: ***Correct: Presbycusis*** - It is the most common cause of **gradual, bilateral sensorineural hearing loss** in the elderly, characterized by a protracted course over several years. - The defining feature is difficulty hearing **high-pitched sounds** (loss of high-frequency hearing) and **poor speech discrimination** in noisy environments, consistent with the clinical picture. - This is age-related cochlear degeneration, typically beginning after age 50-60. *Incorrect: Meniere's disease* - This condition is defined by the classic triad of **episodic vertigo**, **fluctuating (usually low-frequency) sensorineural hearing loss**, and **tinnitus** with aural fullness, none of which are present. - The hearing loss is typically episodic and unilateral, contrasting with the patient's chronic, gradual deterioration. *Incorrect: Otosclerosis* - This disorder causes **conductive hearing loss** (or mixed loss) due to abnormal bone growth around the **stapes footplate**, often presenting earlier in life (20s–30s). - Unlike the gradual, high-frequency loss seen here, otosclerosis causes reduced sound transmission to the inner ear, typically improving speech perception in noise (**paracusis Willisii**). *Incorrect: Acoustic neuroma* - Although it causes sensorineural hearing loss, it is typically **unilateral** and often asymmetrical, frequently accompanied by **unilateral tinnitus** and imbalance. - This diagnosis is less likely in a patient with **bilateral**, gradual hearing loss without unilateral symptoms or specific cranial nerve involvement.