INI-CET 2025 — ENT
5 Previous Year Questions with Answers & Explanations
Which of the following statements regarding Juvenile Nasopharyngeal Angiofibroma (JNA) is NOT typically correct or recommended?
Choose the most appropriate candidates for cochlear implants: 1. Ototoxicity 2. Congenital hearing loss 3. Ossicular fixation 4. Otosclerosis
A 50-year-old female complains of an episode of acute vertigo with vomiting and unsteadiness and light-headedness, which was triggered by changing her head position in the morning. She denied hearing loss, recent viral illness, medication use, head injury, or trauma. Choose the most appropriate diagnosis:
Which of the following is incorrect regarding Juvenile Nasopharyngeal Angiofibroma (JNA)?
A 35-year-old man presents to the emergency department with a complaint of food stuck in his throat. On examination, a bone is seen in the left piriform recess. Which of the following is most likely to be impaired?
INI-CET 2025 - ENT INI-CET Practice Questions and MCQs
Question 1: Which of the following statements regarding Juvenile Nasopharyngeal Angiofibroma (JNA) is NOT typically correct or recommended?
- A. Recurrent epistaxis
- B. Unilateral nasal obstruction
- C. Exclusively to adolescent boys
- D. Biopsy under anesthesia to diagnose (Correct Answer)
Explanation: ***Biopsy under anesthesia to diagnose*** - This statement is incorrect because Juvenile Nasopharyngeal Angiofibroma (JNA) is a highly **vascular tumor**, and diagnostic biopsy carries a significant risk of catastrophic, life-threatening hemorrhage. - Diagnosis is generally established by typical clinical presentation, **CT scan**, and **MRI/Angiography**, which demonstrates the characteristic enhancement and location. *Recurrent epistaxis* - This is the **most common presentation (hallmark symptom)** of JNA, resulting directly from the high concentration of vascular channels within the tumor structure. - The epistaxis is classically described as **profuse and recurrent**. *Unilateral nasal obstruction* - JNA originates in the **posterolateral wall of the nasopharynx** near the sphenopalatine foramen, causing progressive narrowing of the nasal airway on one side. - Due to its characteristic growth pattern, unilateral nasal blockage is a key clinical feature. *Exclusively to adolescence boys* - JNA exhibits an overwhelming predilection for **males** during adolescence (typically 10-25 years old), making this demographic statement correct. - The tumor's pathogenesis is linked to **androgen receptors**, explaining the sex and age dominance.
Question 2: Choose the most appropriate candidates for cochlear implants: 1. Ototoxicity 2. Congenital hearing loss 3. Ossicular fixation 4. Otosclerosis
- A. 3 and 4
- B. 1 and 2 (Correct Answer)
- C. 2 and 3
- D. 1 and 4
Explanation: ***1 and 2*** - **Ototoxicity** can cause severe to profound **sensorineural hearing loss**, which may warrant cochlear implant consideration if hearing aids provide insufficient benefit. - **Congenital hearing loss**, when severe to profound and sensorineural in nature, represents a classic indication for cochlear implantation, especially in children for speech and language development. *3 and 4* - **Ossicular fixation** primarily causes **conductive hearing loss** and is typically managed with **middle ear surgery** (ossiculoplasty), not cochlear implants. - **Otosclerosis** also causes **conductive hearing loss** affecting the stapes bone and is best treated with **stapedectomy**, not cochlear implantation. *2 and 3* - While **congenital hearing loss** can be appropriate for cochlear implants when severe to profound sensorineural, **ossicular fixation** is a **conductive pathology** treated surgically. - Combining a potential cochlear implant candidate with a condition requiring middle ear surgery creates an inappropriate pairing. *1 and 4* - **Ototoxicity** may lead to cochlear implant candidacy if it causes severe sensorineural loss, but **otosclerosis** is primarily a **conductive hearing loss** condition. - **Otosclerosis** responds well to **stapedectomy** with excellent hearing outcomes, making cochlear implantation unnecessary and inappropriate.
Question 3: A 50-year-old female complains of an episode of acute vertigo with vomiting and unsteadiness and light-headedness, which was triggered by changing her head position in the morning. She denied hearing loss, recent viral illness, medication use, head injury, or trauma. Choose the most appropriate diagnosis:
- A. Vestibular neuritis
- B. BPPV (Correct Answer)
- C. Acoustic neuroma
- D. Meniere disease
Explanation: ***Correct: BPPV*** - The characteristic presentation of **acute, brief episodes of vertigo** triggered specifically by **changing head position** (positional vertigo) is the hallmark of Benign Paroxysmal Positional Vertigo. - The absence of associated symptoms like **hearing loss**, new medications, or antecedent **viral illness** further supports BPPV, which is caused by dislodged **otoconia** floating in the semicircular canals. *Incorrect: Meniere disease* - This diagnosis is characterized by a specific triad: episodic vertigo, **fluctuating sensorineural hearing loss**, and **tinnitus** (aural fullness), which are absent in this presentation. - Vertigo attacks in Meniere disease are typically severe but **not necessarily positionally triggered** in the classic sense, lasting minutes to hours. *Incorrect: Vestibular neuritis* - Vestibular neuritis (or labyrinthitis if hearing is involved) causes a single, severe, **prolonged attack of vertigo** that lasts for days, not brief, positional episodes. - It is often preceded by a recent upper **respiratory tract infection** or viral syndrome, which the patient explicitly denied. *Incorrect: Acoustic neuroma* - An acoustic neuroma (**Vestibular Schwannoma**) typically presents with **slowly progressive unilateral sensorineural hearing loss** and **tinnitus**, often for months or years. - Acute, recurrent, positionally-triggered vertigo with vomiting is extremely atypical, as the symptoms caused by this tumor are usually **gradual** due to slow growth.
Question 4: Which of the following is incorrect regarding Juvenile Nasopharyngeal Angiofibroma (JNA)?
- A. Biopsy is contraindicated
- B. Epistaxis is the most common presenting symptom
- C. Unilateral cervical lymph nodes are a common feature (Correct Answer)
- D. Only seen in young boys
Explanation: ***Unilateral cervical lymph nodes are a common feature*** - This is the **INCORRECT** statement (correct answer for this negation question). - JNA is a **benign, non-metastatic tumor**; therefore, cervical lymphadenopathy is **NOT** a characteristic feature. - Palpable lymph nodes would suggest an inflammatory, infectious, or malignant process, which JNA is not. *Epistaxis is the most common presenting symptom* - This is a **correct** statement about JNA. - **Recurrent, profuse epistaxis** (nosebleeds) is indeed the most common presenting symptom due to the tumor's highly vascular nature. - The tumor is composed of numerous thin-walled blood vessels lacking smooth muscle, leading to easy bleeding. *Only seen in young boys* - This is a **correct** statement about JNA. - JNA almost exclusively occurs in **adolescent males** (typically between 10 and 25 years old) due to its androgen-dependent nature. - The extreme rarity in females suggests a strong hormonal etiology related to male sex hormones. *Biopsy is contraindicated* - This is a **correct** statement about JNA. - Biopsy is strictly **contraindicated** due to the high risk of **catastrophic, life-threatening hemorrhage**. - Diagnosis is typically made clinically and confirmed by high-resolution imaging (CT/MRI) showing a classic enhancing mass at the **sphenopalatine foramen** in the posterolateral nasopharynx.
Question 5: A 35-year-old man presents to the emergency department with a complaint of food stuck in his throat. On examination, a bone is seen in the left piriform recess. Which of the following is most likely to be impaired?
- A. Cough reflex
- B. Salivation
- C. Gag reflex (Correct Answer)
- D. Mastication
Explanation: ***Gag reflex*** - The **piriform recess (piriform fossa)** is located within the **hypopharynx**, lateral to the laryngeal opening, and is part of the pharyngeal space where the gag reflex is mediated. - A foreign body (bone) lodged in the piriform recess would **directly stimulate and affect** the **gag reflex** by irritating the pharyngeal mucosa innervated by the **glossopharyngeal nerve (CN IX)** (afferent limb) and **vagus nerve (CN X)** (efferent limb). - The **superior laryngeal nerve** (internal branch), which supplies sensation to the piriform fossa, contributes to triggering the gag reflex when this area is stimulated by a foreign body. - This makes the gag reflex the **most directly affected reflex** in this clinical scenario, as the foreign body is in direct contact with the pharyngeal structures that mediate this protective reflex. *Incorrect: Cough reflex* - The cough reflex is primarily mediated by sensory innervation from the **vagus nerve (CN X)** to the **larynx below the vocal cords, trachea, and bronchi**. - While the piriform recess is adjacent to the laryngeal inlet, a foreign body lodged here typically causes dysphagia and affects the gag reflex rather than primarily impairing the cough reflex. - The cough reflex would be more affected if the foreign body were aspirated into the larynx or trachea. *Incorrect: Mastication* - Mastication (chewing) is controlled by the **trigeminal nerve (CN V)**, which innervates the muscles of mastication (masseter, temporalis, pterygoids). - These structures are located in the oral cavity and are anatomically distant from the piriform recess. - A foreign body in the hypopharynx causes **dysphagia** (difficulty swallowing) and **odynophagia** (painful swallowing), not difficulty with chewing. *Incorrect: Salivation* - Salivation is controlled by parasympathetic innervation via the **facial nerve (CN VII)** (submandibular and sublingual glands) and **glossopharyngeal nerve (CN IX)** (parotid gland). - While pain or discomfort from a foreign body might reflexively affect salivation, this is an indirect effect and not the primary reflex associated with the piriform recess. - The neurological pathways controlling salivary secretion are not directly impaired by a foreign body in the pharynx.