NEET-PG 2022 — ENT

Q: A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

Otitis media with effusion. ***Otitis media with effusion*** - The image clearly shows the presence of **bubbles behind the tympanic membrane**, indicating fluid accumulation in the middle ear. - This fluid leads to **reduced hearing**, as reported in the 5-year-old child, consistent with otitis media with effusion (OME), also known as "glue ear." *Myringitis* - Myringitis typically presents with **inflammation of the tympanic membrane**, often with vesicles or bullae on the drum, which are not visible here. - While it can cause pain, it does not typically show the characteristic bubbles signifying middle ear effusion. *Acute ear infection* - An **acute otitis media** would show a **bulging, erythematous (red), and opaque tympanic membrane** due to inflammation and pus, which is not consistent with the image. - Systemic symptoms like fever and severe ear pain would also be expected with an acute infection. *Air in the middle ear* - The presence of **air in the middle ear is normal** and indicates a healthy, functioning Eustachian tube. - The visible bubbles in the image are consistent with **fluid and air-fluid levels**, not just air, and indicate a pathological condition affecting hearing. [Practice more ENT PYQs on OnCourse]

Q: A 45-year-old patient complained of pain on one side of the neck. She is afraid of eating food as it worsens the pain. An ultrasound of the salivary glands is shown below. What is the most likely diagnosis?

Sialolithiasis. ***Sialolithiasis*** - The ultrasound image shows an **echogenic focus** with clear **posterior acoustic shadowing** within the salivary gland, which is characteristic of a salivary gland stone. - The patient's symptoms of **pain on one side of the neck** and **worsening pain with eating** (likely due to salivary stimulation) are classic for **sialolithiasis**, as the stone obstructs salivary flow. *Salivary gland foreign body* - While a foreign body could present with similar pain, it would typically appear as a distinct object on ultrasound, but its echogenicity and shading characteristics might differ depending on the material. - The history of a foreign body ingestion or insertion would be crucial, which is not mentioned here. *Cervical lymphadenopathy* - **Lymph nodes** on ultrasound typically appear as oval-shaped structures with a **hypoechoic cortex** and an **echogenic hilum**; they do not usually show significant acoustic shadowing unless calcified. - While cervical lymphadenopathy can cause neck pain, it is not typically exacerbated by eating in the same way an obstructed salivary gland would be. *Osteoma of the floor of the mouth* - An **osteoma** is a **benign bone tumor** that would present as a very **dense, highly echogenic mass** with severe posterior acoustic shadowing on ultrasound, originating from bony structures. - While an osteoma could cause pain, its location (floor of the mouth) and nature would not typically explain pain worsening specifically with eating due to salivary gland obstruction. [Practice more ENT PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

A 45-year-old patient complained of pain on one side of the neck. She is afraid of eating food as it worsens the pain. An ultrasound of the salivary glands is shown below. What is the most likely diagnosis?

NEET-PG 2022 - ENT NEET-PG Practice Questions and MCQs

Question 1: A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

A. Myringitis
B. Otitis media with effusion (Correct Answer)
C. Acute ear infection
D. Air in the middle ear

Explanation: ***Otitis media with effusion*** - The image clearly shows the presence of **bubbles behind the tympanic membrane**, indicating fluid accumulation in the middle ear. - This fluid leads to **reduced hearing**, as reported in the 5-year-old child, consistent with otitis media with effusion (OME), also known as "glue ear." *Myringitis* - Myringitis typically presents with **inflammation of the tympanic membrane**, often with vesicles or bullae on the drum, which are not visible here. - While it can cause pain, it does not typically show the characteristic bubbles signifying middle ear effusion. *Acute ear infection* - An **acute otitis media** would show a **bulging, erythematous (red), and opaque tympanic membrane** due to inflammation and pus, which is not consistent with the image. - Systemic symptoms like fever and severe ear pain would also be expected with an acute infection. *Air in the middle ear* - The presence of **air in the middle ear is normal** and indicates a healthy, functioning Eustachian tube. - The visible bubbles in the image are consistent with **fluid and air-fluid levels**, not just air, and indicate a pathological condition affecting hearing.

Question 2: A 45-year-old patient complained of pain on one side of the neck. She is afraid of eating food as it worsens the pain. An ultrasound of the salivary glands is shown below. What is the most likely diagnosis?

A. Sialolithiasis (Correct Answer)
B. Salivary gland foreign body
C. Cervical lymphadenopathy
D. Osteoma of the floor of the mouth

Explanation: ***Sialolithiasis*** - The ultrasound image shows an **echogenic focus** with clear **posterior acoustic shadowing** within the salivary gland, which is characteristic of a salivary gland stone. - The patient's symptoms of **pain on one side of the neck** and **worsening pain with eating** (likely due to salivary stimulation) are classic for **sialolithiasis**, as the stone obstructs salivary flow. *Salivary gland foreign body* - While a foreign body could present with similar pain, it would typically appear as a distinct object on ultrasound, but its echogenicity and shading characteristics might differ depending on the material. - The history of a foreign body ingestion or insertion would be crucial, which is not mentioned here. *Cervical lymphadenopathy* - **Lymph nodes** on ultrasound typically appear as oval-shaped structures with a **hypoechoic cortex** and an **echogenic hilum**; they do not usually show significant acoustic shadowing unless calcified. - While cervical lymphadenopathy can cause neck pain, it is not typically exacerbated by eating in the same way an obstructed salivary gland would be. *Osteoma of the floor of the mouth* - An **osteoma** is a **benign bone tumor** that would present as a very **dense, highly echogenic mass** with severe posterior acoustic shadowing on ultrasound, originating from bony structures. - While an osteoma could cause pain, its location (floor of the mouth) and nature would not typically explain pain worsening specifically with eating due to salivary gland obstruction.