NEET-PG 2023 — ENT

Q: A female patient presents with hearing loss. Rinne test results show Rinne negative at 256 Hz and 512 Hz, while Rinne positive at 1024 Hz. Based on these findings, what is the expected air conduction and bone conduction gap?

15-30 dB. ***15-30 dB*** - The pattern of **Rinne negative at 256 Hz and 512 Hz** combined with **Rinne positive at 1024 Hz** is characteristic of a **mild to moderate conductive hearing loss** with an air-bone gap in the **15-30 dB range**. - In this range, the conductive component is sufficient to cause Rinne negativity at lower frequencies where bone conduction is more efficient, but at higher frequencies (1024 Hz), the gap narrows and air conduction becomes relatively better, resulting in a positive Rinne test. - This frequency-dependent pattern indicates the air-bone gap is **closing at higher frequencies**, typical of mild conductive losses. *30-45 dB* - An air-bone gap of **30-45 dB** represents a **moderate conductive hearing loss** where Rinne test would remain **negative across all frequencies** including 1024 Hz. - At this magnitude of conductive loss, bone conduction would still significantly exceed air conduction even at higher frequencies. - The transition to Rinne positive at 1024 Hz would NOT occur with this degree of hearing loss. *45-60 dB* - This represents a **moderate-severe conductive hearing loss** with a substantial air-bone gap. - Rinne test would be **strongly negative across all tested frequencies** without exception. - The large gap would prevent any frequency from showing air conduction superiority. *>60 dB* - This indicates a **severe to profound conductive hearing loss** with a very large air-bone gap. - Rinne test would be **markedly negative at all frequencies**, with bone conduction dramatically exceeding air conduction. - Air conduction may be barely perceptible or absent at this level of loss. [Practice more ENT PYQs on OnCourse]

Q: A 50-year-old smoker presents with hoarseness, dysphagia, and weight loss. Flexible laryngoscopy shows a mass on the vocal cords. What is the next best step?

Direct laryngoscopy with biopsy. ***Direct laryngoscopy with biopsy*** - A definitive diagnosis of a vocal cord mass requires **histological examination** to rule out malignancy, especially given the patient's risk factors (age, smoking) and symptoms (hoarseness, dysphagia, weight loss). - **Direct laryngoscopy** allows for a thorough, magnified view of the mass and precise biopsy collection, which is superior to flexible laryngoscopy alone for definitive diagnosis and staging. *MRI of neck* - While MRI can provide excellent soft tissue detail for **staging** a known malignancy, it cannot provide a **histological diagnosis**. - It would typically be performed after a biopsy confirms malignancy to assess the extent of the tumor and potential spread. *CT scan of neck* - A CT scan is useful for evaluating **bony involvement**, lymph node status, and tumor extension for **staging purposes**, but it is not a diagnostic tool for identifying the specific type of tissue or cell pathology. - Like MRI, a CT scan would generally follow a biopsy confirming malignancy. *Radiotherapy* - **Radiotherapy** is a treatment modality for laryngeal cancer, not a diagnostic step. - Initiating treatment without a definitive histological diagnosis of malignancy would be inappropriate and potentially harmful. [Practice more ENT PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

A female patient presents with hearing loss. Rinne test results show Rinne negative at 256 Hz and 512 Hz, while Rinne positive at 1024 Hz. Based on these findings, what is the expected air conduction and bone conduction gap?

A 50-year-old smoker presents with hoarseness, dysphagia, and weight loss. Flexible laryngoscopy shows a mass on the vocal cords. What is the next best step?

NEET-PG 2023 - ENT NEET-PG Practice Questions and MCQs

Question 1: A female patient presents with hearing loss. Rinne test results show Rinne negative at 256 Hz and 512 Hz, while Rinne positive at 1024 Hz. Based on these findings, what is the expected air conduction and bone conduction gap?

A. 30-45 dB
B. 15-30 dB (Correct Answer)
C. 45-60 dB
D. >60 dB

Explanation: ***15-30 dB*** - The pattern of **Rinne negative at 256 Hz and 512 Hz** combined with **Rinne positive at 1024 Hz** is characteristic of a **mild to moderate conductive hearing loss** with an air-bone gap in the **15-30 dB range**. - In this range, the conductive component is sufficient to cause Rinne negativity at lower frequencies where bone conduction is more efficient, but at higher frequencies (1024 Hz), the gap narrows and air conduction becomes relatively better, resulting in a positive Rinne test. - This frequency-dependent pattern indicates the air-bone gap is **closing at higher frequencies**, typical of mild conductive losses. *30-45 dB* - An air-bone gap of **30-45 dB** represents a **moderate conductive hearing loss** where Rinne test would remain **negative across all frequencies** including 1024 Hz. - At this magnitude of conductive loss, bone conduction would still significantly exceed air conduction even at higher frequencies. - The transition to Rinne positive at 1024 Hz would NOT occur with this degree of hearing loss. *45-60 dB* - This represents a **moderate-severe conductive hearing loss** with a substantial air-bone gap. - Rinne test would be **strongly negative across all tested frequencies** without exception. - The large gap would prevent any frequency from showing air conduction superiority. *>60 dB* - This indicates a **severe to profound conductive hearing loss** with a very large air-bone gap. - Rinne test would be **markedly negative at all frequencies**, with bone conduction dramatically exceeding air conduction. - Air conduction may be barely perceptible or absent at this level of loss.

Question 2: A 50-year-old smoker presents with hoarseness, dysphagia, and weight loss. Flexible laryngoscopy shows a mass on the vocal cords. What is the next best step?

A. Direct laryngoscopy with biopsy (Correct Answer)
B. MRI of neck
C. CT scan of neck
D. Radiotherapy

Explanation: ***Direct laryngoscopy with biopsy*** - A definitive diagnosis of a vocal cord mass requires **histological examination** to rule out malignancy, especially given the patient's risk factors (age, smoking) and symptoms (hoarseness, dysphagia, weight loss). - **Direct laryngoscopy** allows for a thorough, magnified view of the mass and precise biopsy collection, which is superior to flexible laryngoscopy alone for definitive diagnosis and staging. *MRI of neck* - While MRI can provide excellent soft tissue detail for **staging** a known malignancy, it cannot provide a **histological diagnosis**. - It would typically be performed after a biopsy confirms malignancy to assess the extent of the tumor and potential spread. *CT scan of neck* - A CT scan is useful for evaluating **bony involvement**, lymph node status, and tumor extension for **staging purposes**, but it is not a diagnostic tool for identifying the specific type of tissue or cell pathology. - Like MRI, a CT scan would generally follow a biopsy confirming malignancy. *Radiotherapy* - **Radiotherapy** is a treatment modality for laryngeal cancer, not a diagnostic step. - Initiating treatment without a definitive histological diagnosis of malignancy would be inappropriate and potentially harmful.