FMGE 2026 Practice Questions

Q: Which among the following structures is used for facial nerve identification?

Digastric. ***Digastric*** - The **posterior belly of the digastric muscle** is a reliable anatomical landmark used during parotid surgery to identify the **facial nerve** trunk as it exits the **stylomastoid foramen**. - The nerve lies superficial to the **digastric muscle** and deep to the parotid gland, making the muscle's superior border a crucial guide. *Sternocleidomastoid* - The **sternocleidomastoid** muscle is located posterior to the parotid gland and serves as a surgical boundary, but it is not the specific landmark for nerve identification. - While the **facial nerve** lies anterior to the **sternocleidomastoid**, it is not the primary structure used to locate the nerve trunk itself. *Tragus* - The **tragus** (specifically the **tragal pointer** or cartilage) is a surface anatomical landmark used to approximate the location of the **facial nerve**'s exit from the skull. - It is a useful external reference point, but surgeons rely on the **digastric muscle** or the **tympanomastoid suture** for precise intraoperative identification. *Lateral border of lip* - The **lateral border of the lip** is where peripheral branches of the **facial nerve** terminate, not where the main trunk is identified. - Using this as a point of identification would be ineffective as it is distal to the surgical site where the nerve trunk is first located.

Q: A chronic smoker presents with a low -pitched, husky voice. Indirect laryngoscopy reveals findings as shown in the image. What is the most likely diagnosis?

Reinke’s edema. ***Reinke's edema*** - This condition is strongly associated with **chronic smoking** and presents classically as **bilateral, gelatinous swelling** of the **superficial lamina propria** of the vocal cords. - It results in the characteristic **low-pitched, husky voice** (dysphonia) due to increased mass of the vocal folds, which is pathognomonic when seen on laryngoscopy. *Vocal cord polyp* - Usually presents as a **unilateral** lesion, often related to acute trauma or **vocal abuse** rather than chronic smoking alone. - These lesions are typically more **localized** and pedunculated or sessile rather than the diffuse, sausage-like swelling seen in Reinke's. *Bilateral vocal cord cyst* - Cysts are typically **non-smoker related** and arise from **ductal obstruction** of mucus-secreting glands in the vocal cord. - They appear as discrete, **fluid-filled swellings** beneath the epithelium, appearing distinct from the diffuse, grayish edema characteristic of Reinke's. *Laryngeal papillomatosis* - This condition is caused by **Human Papillomavirus (HPV)** and typically presents as multiple **wart-like, friable growths** on the vocal cords. - It is generally seen in younger patients (children or young adults) and manifests with progressive **hoarseness** and potential **airway obstruction**.

Q: A child presents with a history of accidental coin ingestion. The X -ray is as shown in the image. The coin is most likely lodged in which site?

Esophagus. ***Esophagus*** - Foreign bodies, such as coins, classically lodge in the **esophagus** at the **cricopharyngeus muscle** (the narrowest part of the upper esophagus), making it the most common site for entrapment. - On an **AP X-ray view**, esophageal coins appear **en face** (round shape) because the esophagus is located posterior to the trachea, leading to a coronal orientation of the object. *Larynx* - The **larynx** is part of the airway, and a foreign body here would typically present with acute **respiratory distress**, stridor, or cyanosis rather than being an incidental radiographic finding. - Radiographically, an object in the larynx would be oriented in the sagittal plane, appearing **on edge** rather than as a round coin. *Trachea* - Tracheal foreign bodies cause significant **airway obstruction**, manifesting as wheezing, cough, or severe dyspnea, which differs from the clinical presentation of a stable, asymptomatic coin ingestion. - Like the larynx, objects within the **trachea** are oriented sagittally due to the anterior-posterior alignment of the airway, presenting as an **on edge** shadow on an AP radiograph. *Hypopharynx* - While a foreign body can lodge in the **pyriform fossa** of the hypopharynx, this location is significantly less common than the **cricopharyngeus** for coin impaction. - Persistent foreign bodies in the **hypopharynx** usually cause difficulty swallowing (dysphagia) or sialorrhea rather than the classically asymptomatic presentation seen with esophageal coins.

Q: A 58-year-old man, chronic smoker, presents with progressive hoarseness of voice and throat discomfort for 4 months. Laryngoscopy reveals a laryngeal growth, and neck examination shows a single ipsilateral, mobile cervical lymph node. Biopsy confirms squamous cell carcinoma of the larynx. What is the most appropriate treatment?

Chemoradiotherapy. ***Chemoradiotherapy*** * For locally advanced laryngeal cancer or cases with nodal involvement (N1), organ preservation protocols using **concurrent chemoradiotherapy** are the standard of care. * This approach is preferred for patients capable of tolerating intensive therapy to avoid the functional morbidity associated with total laryngectomy, while maintaining comparable survival rates. *Radiotherapy alone* * While radiotherapy is a viable option for early-stage (T1/T2) laryngeal cancer, it is insufficient for advanced or N-positive cases. * In cases with nodal involvement, adding chemotherapy improves locoregional control and patient survival compared to radiation alone. *Partial laryngectomy* * This procedure is generally reserved for small, localized lesions (usually early T-stage) where the tumor is confined to a specific part of the larynx. * It is unsuitable for patients with significant nodal involvement, which requires a more comprehensive approach typically involving systemic therapy. *Total laryngectomy* * Reserved for advanced T4 tumors, salvage therapy after recurrence, or patients unfit for organ preservation protocols. * Since the tumor is potentially responsive to non-surgical organ preservation strategies, committing the patient to the permanent loss of the voice box is not the first-line intervention.

Q: A patient presents with an ulcer on the posterior pharyngeal wall, as shown in the image. This lesion most likely originates from which structure?

Pharyngeal mucosa. ***Pharyngeal mucosa*** - Ulcers on the posterior pharyngeal wall are frequently associated with mucosal pathologies, where the loss of epithelial continuity exposes the underlying connective tissue. - This structure is the primary site of origin for inflammatory, infectious, or sometimes early neoplastic lesions in the oropharynx. *Minor salivary glands* - Lesions originating from minor salivary glands are typically firm, nodular, or present as a painless swelling rather than a primary ulcerated base. - These glands are usually located within the submucosa, and while their pathology can lead to surface ulceration, it is less common than primary mucosal lesions. *Subepithelial region* - Pathology arising primarily in the subepithelium often manifests as masses, cysts, or deep-seated abscesses rather than superficial mucosal ulceration. - Lesions here are more likely to cause displacement of the mucosa rather than immediate surface destruction. *Lymphoid tissue* - While lymphoid tissue (like the pharyngeal tonsils/adenoids) is abundant in the pharynx, primary ulceration is uncommon unless associated with specific pathologies like infectious mononucleosis or lymphoma. - Hypertrophy (enlargement) is the most frequent clinical presentation of lymphoid tissue, rather than singular ulceration.

Q: A patient presents with a swelling in the floor of the mouth, as shown in the image. The swelling is painless and gradually increasing in size. What is the most likely diagnosis?

Ranula. ***Ranula*** - A ranula is a **mucus extravasation phenomenon** involving the **sublingual gland**, typically presenting as a painless, blue, translucent swelling in the floor of the mouth. - It specifically refers to this pathology occurring in the **sublingual space**, distinguishing it from mucoceles found elsewhere in the oral cavity. *Ludwig’s angina* - This is a rapidly progressive **bacterial infection** (cellulitis) of the submandibular space, presenting with **pain**, **fever**, and **airway compromise**, unlike the painless swelling described. - Clinical features include a **woody induration** of the neck and **elevated tongue**, appearing as a medical emergency, not a chronic, simple swelling. *Mucocele* - A mucocele is a general term for a lesion caused by **trauma** or obstruction of minor salivary gland ducts, occurring most commonly on the **lower lip**. - While pathologically similar to a ranula (mucus extravasation), the term **ranula** is specifically reserved for extravasation phenomenon involving the **sublingual gland** in the floor of the mouth. *Dermoid cyst* - A dermoid cyst is a **developmental, midline** lesion typically containing **keratin** and adnexal structures, often feeling doughy or fluctuant on palpation. - Unlike the translucent blue appearance of a ranula, dermoid cysts usually match the color of the surrounding **mucosa** and are slow-growing, congenital-like lesions.

Q: A 40 year old presented with bilateral hearing loss. Audiogram shows a dip at 2000 Hz. What is the most appropriate investigation?

Impedance audiometry. ### ***Impedance audiometry*** - In a patient with **otosclerosis**, the characteristic **Carhart's notch** (a dip at 2000 Hz on bone conduction audiometry) is a hallmark finding due to stapes fixation. - **Impedance audiometry** (specifically **tympanometry**) will demonstrate a **Type As tympanogram**, indicating reduced compliance of the tympanic membrane due to increased stiffness of the ossicular chain. ### *BERA* - **Brainstem Evoked Response Audiometry** (BERA) is primarily used for **retro-cochlear pathology** like **vestibular schwannomas** or in pediatric audiology screening. - While it can assess hearing thresholds, it is not the standard next diagnostic step for evaluating **conductive hearing loss** caused by stapes fixation. ### *Otoacoustic emissions* - **Otoacoustic emissions** (OAEs) are used to assess **outer hair cell function** in the cochlea, largely for neonatal hearing screening. - They do not provide diagnostic utility for middle ear pathologies like otosclerosis, as the sound energy cannot effectively enter or exit the middle ear. ### *Pure tone audiometry* - While **pure tone audiometry** is essential for establishing the diagnosis and identifying the **Carhart's notch**, it has already been performed in this scenario. - The clinical question asks for the *most appropriate investigation* to confirm the specific pathology (middle ear conduction system stiffness) implied by the audiogram findings.

Q: What is the treatment of choice for Rhinoscleroma?

Long term antibiotics with surgical debulking. ***Long term antibiotics with surgical debulking*** - Rhinoscleroma is a chronic granulomatous infection caused by **Klebsiella rhinoscleromatis**, requiring prolonged treatment, often with **tetracyclines**, **fluoroquinolones**, or **trimethoprim-sulfamethoxazole**, typically for months to prevent recurrence. - **Surgical debulking** is essential for cases with airway obstruction or heavy fibrotic tissue (

Q: A 2-month-old infant is brought to the pediatric clinic with a history of high-pitched inspiratory stridor that began shortly after birth. The mother notes that the sound is most noticeable when the baby is crying or feeding. Which of the following is true regarding the diagnosis?

Omega sign improves in the prone position. ***Omega sign improves in the prone position*** - The clinical presentation of chronic, high-pitched inspiratory stridor starting shortly after birth, which worsens with agitation or feeding, is classic for **laryngomalacia**. The hallmark finding on laryngoscopy is an omega-shaped (Ω) **epiglottis** that collapses inward during inspiration; placing the infant in a **prone position** often relieves airway obstruction by allowing the supraglottic tissues to fall forward. *Thumb sign improves in the supine position* - The **thumb sign** is a classic radiographic finding on a lateral neck X-ray indicative of **epiglottitis**, a medical emergency involving inflammation of the epiglottis. Laryngomalacia is a chronic, benign condition, whereas epiglottitis presents with acute onset drooling, tripod positioning, and fever, which are not described in this infant. *Steeple sign is characteristic* - The **steeple sign** seen on AP neck X-rays is diagnostic for **croup** (laryngotracheobronchitis), which typically presents with a barking cough and is caused by parainfluenza virus. This condition usually occurs in older infants and typically presents with acute symptoms rather than a chronic stridor persisting since birth. *Cherry-red epiglottis sign is characteristic* - A **cherry-red epiglottis** observed during examination is a specific sign of acute, bacterial **epiglottitis**, usually caused by *Haemophilus influenzae* type b. This condition presents with rapidly progressive respiratory distress and dysphagia, and looking in the throat is strictly contraindicated due to the risk of precipitating total airway obstruction.

Q: What is the best and safest site for performing a tracheostomy?

Between the 2nd and 3rd tracheal rings. ***Between the 2nd and 3rd tracheal rings*** - This specific location is widely considered the **optimal site** for an elective tracheostomy as it avoids the **cricoid cartilage** (reducing risk of stenosis) and maintains adequate distance from the thyroid isthmus and great vessels. - Accessing this space allows for a safe procedure while minimizing the risk of accidental **damage to the cricoid cartilage**, which is the only complete ring of the airway. *Through the cricothyroid membrane* - This anatomical landmark is reserved for **emergency cricothyroidotomy**, not a standard elective tracheostomy. - Incising here carries a significant risk of **subglottic stenosis** and laryngeal injury due to the proximity to the true vocal cords. *Between the 4th and 5th tracheal rings* - While technically possible, this site is generally placed **too low** in the neck. - Placing an incision this low increases the risk of injuring the large **thyroid veins** or the **brachiocephalic (innominate) artery**, particularly if the neck is hyper-extended. *Just below the cricoid cartilage* - An incision placed immediately below the cricoid cartilage is avoided because it risks damaging the **cricoid cartilage ring** itself, which provides essential structural support to the airway. - This position significantly increases the long-term risk of **subglottic stenosis**, a severe and difficult-to-manage airway complication.

Question 1

Which among the following structures is used for facial nerve identification?

Accepted Answer

Digastric

Answer

Sternocleidomastoid

Answer

Tragus

Answer

Lateral border of lip

Question 2

A chronic smoker presents with a low -pitched, husky voice. Indirect laryngoscopy reveals findings as shown in the image. What is the most likely diagnosis?

Accepted Answer

Reinke’s edema

Answer

Vocal cord polyp

Answer

Bilateral vocal cord cyst

Answer

Laryngeal papillomatosis

Question 3

A child presents with a history of accidental coin ingestion. The X -ray is as shown in the image. The coin is most likely lodged in which site?

Accepted Answer

Esophagus

Answer

Larynx

Answer

Trachea

Answer

Hypopharynx

Question 4

A 58-year-old man, chronic smoker, presents with progressive hoarseness of voice and throat discomfort for 4 months. Laryngoscopy reveals a laryngeal growth, and neck examination shows a single ipsilateral, mobile cervical lymph node. Biopsy confirms squamous cell carcinoma of the larynx. What is the most appropriate treatment?

Accepted Answer

Chemoradiotherapy

Answer

Radiotherapy alone

Answer

Partial laryngectomy

Answer

Total laryngectomy

Question 5

A patient presents with an ulcer on the posterior pharyngeal wall, as shown in the image. This lesion most likely originates from which structure?

Accepted Answer

Pharyngeal mucosa

Answer

Minor salivary glands

Answer

Subepithelial region

Answer

Lymphoid tissue

Question 6

A patient presents with a swelling in the floor of the mouth, as shown in the image. The swelling is painless and gradually increasing in size. What is the most likely diagnosis?

Accepted Answer

Ranula

Answer

Ludwig’s angina

Answer

Mucocele

Answer

Dermoid cyst

Question 7

A 40 year old presented with bilateral hearing loss. Audiogram shows a dip at 2000 Hz. What is the most appropriate investigation?

Accepted Answer

Impedance audiometry

Answer

BERA

Answer

Otoacoustic emissions

Answer

Pure tone audiometry

Question 8

What is the treatment of choice for Rhinoscleroma?

Accepted Answer

Long term antibiotics with surgical debulking

Answer

Corticosteroids with antihistamines

Answer

Radiotherapy

Answer

Short course oral antibiotics with nasal decongestants

Question 9

A 2-month-old infant is brought to the pediatric clinic with a history of high-pitched inspiratory stridor that began shortly after birth. The mother notes that the sound is most noticeable when the baby is crying or feeding. Which of the following is true regarding the diagnosis?

Accepted Answer

Omega sign improves in the prone position

Answer

Thumb sign improves in the supine position

Answer

Steeple sign is characteristic

Answer

Cherry-red epiglottis sign is characteristic

Question 10

What is the best and safest site for performing a tracheostomy?

Accepted Answer

Between the 2nd and 3rd tracheal rings

Answer

Through the cricothyroid membrane

Answer

Between the 4th and 5th tracheal rings

Answer

Just below the cricoid cartilage

FMGE 2026

Anatomy

ENT

Pediatrics

Surgery