NEET-PG 2024 - ENT PYQs Practice Questions

Q: A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?

Cricothyroid. ***Cricothyroid*** - The **cricothyroid muscle** is primarily responsible for **tensioning and elongating the vocal cords**, which is crucial for increasing vocal pitch. - Damage to this muscle or its innervation (superior laryngeal nerve) results in an inability to reach higher pitches and can cause **vocal cord bowing** due to reduced tension. *Posterior cricoarytenoid* - This muscle is the **primary abductor** of the vocal cords, meaning it opens the vocal cords for breathing. - Compromise would lead to difficulty breathing or a paralyzed vocal cord in the adducted position, not bowing with difficulty singing high notes. *Lateral cricoarytenoid* - The **lateral cricoarytenoid muscle** is a **vocal cord adductor** and rotator, bringing the vocal cords together to regulate voice intensity. - Dysfunction typically results in a weak and breathy voice, or difficulty bringing the cords together, not specifically difficulty with high pitch. *Thyroarytenoid* - The **thyroarytenoid muscle** (which includes the vocalis muscle) acts to **relax and shorten the vocal cords**, lowering pitch and modulating vocal cord tension. - Dysfunction would primarily lead to difficulty with lower pitches or a hoarse voice, as it prevents proper relaxation of the vocal cords. [Practice more ENT PYQs on OnCourse]

Q: In a patient with right vestibular neuronitis, what will be the finding on the head impulse test?

Head turned to right, corrective saccade to the left. ***Head turned to right, corrective saccade to the left*** - In **right vestibular neuronitis**, the right vestibular apparatus is impaired, affecting the **vestibulo-ocular reflex (VOR)** on that side. - During the head impulse test, when the head is rapidly turned **to the right** (toward the affected side), the impaired VOR cannot maintain eye fixation on the target. - The eyes initially move **with the head** (to the right), then a visible **corrective saccade** (catch-up saccade) brings them **back to the left** to refixate on the target. - This corrective saccade is the **hallmark positive finding** in head impulse test for right vestibular dysfunction. *Head turned to left, corrective saccade to the right* - This would indicate a **left vestibular lesion**, not right vestibular neuronitis. - When turning the head to the left with left vestibular dysfunction, a corrective saccade to the right would be observed. *Head turned to right, no corrective saccade* - This would indicate **normal VOR function** on the right side. - A normal response shows no corrective saccade because the eyes maintain fixation throughout the head turn. - This is the **opposite** of what is expected in right vestibular neuronitis. *Head turned to left, no corrective saccade* - This indicates normal VOR function on the left side. - In right vestibular neuronitis, turning the head to the left (away from the affected side) typically shows **normal VOR** with no corrective saccade needed. [Practice more ENT PYQs on OnCourse]

Q: A patient presents with conductive hearing loss, pulsatile tinnitus, and a positive Phelps sign. Based on the CT scan image provided, what is the most likely diagnosis?

Glomus Jugulare. ***Glomus Jugulare*** - The symptoms of **conductive hearing loss**, **pulsatile tinnitus**, and a **positive Phelps sign** (destruction of the bone separating the carotid artery from the jugular bulb on CT) are classic for a glomus jugulare tumor. - The CT scan image, showing a destructive lesion in the **jugular foramen** region, further supports this diagnosis, as these tumors originate from the paraganglia of the jugular bulb. *Glomus Tympanicum* - While it can cause conductive hearing loss and pulsatile tinnitus, a glomus tympanicum tumor is typically **confined to the middle ear cavity** and does not involve bone erosion of the jugular foramen as indicated by a positive Phelps sign. - The CT findings would show a mass in the middle ear, often behind an intact tympanic membrane, rather than extensive bone destruction in the jugular region. *Acoustic Neuroma* - This tumor, also known as a **vestibular schwannoma**, primarily causes **sensorineural hearing loss**, **tinnitus** (often non-pulsatile), and **balance issues**, not conductive hearing loss or pulsatile tinnitus. - An acoustic neuroma is located in the **cerebellopontine angle** and internal auditory canal, and the CT scan would show a mass in this specific location, not necessarily bone erosion of the jugular foramen. *Cholesteatoma* - A cholesteatoma is a **destructive, expanding growth of keratinizing squamous epithelium** in the middle ear or mastoid, typically presenting with **conductive hearing loss**, **otorrhea**, and sometimes headaches. - It does not typically cause pulsatile tinnitus unless it's very large and vascularized, nor does it present with the characteristic destruction of the jugular foramen seen with a positive Phelps sign. [Practice more ENT PYQs on OnCourse]

Q: A patient with chronic nasal obstruction underwent a procedure 3 months ago and now presents with recurrent epistaxis, crusting, and the clinical image showing a septal perforation. What procedure was most likely carried out?

Submucosal resection (SMR). ***Submucosal resection (SMR)*** - **SMR** involves removing cartilage or bone from the nasal septum while preserving the septal mucosa. If both mucosal flaps are inadvertently damaged or devitalized during the procedure, it can lead to a **septal perforation** as a complication. - The symptoms of **recurrent epistaxis** and **crusting** are classic signs associated with compromised septal integrity and airflow changes due to a septal perforation, which commonly occurs weeks to months after such a procedure. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is primarily used to treat chronic sinusitis by opening and ventilating the sinuses; it does not directly involve the nasal septum in a way that typically causes perforation. - While complications are possible, a septal perforation is not a common or direct consequence of FESS, which focuses on ethmoid, maxillary, frontal, or sphenoid sinus drainage pathways. *Caldwell-Luc's procedure* - The **Caldwell-Luc procedure** involves an incision above the canine fossa to access the maxillary sinus. - It is specifically aimed at the maxillary sinus and does not involve surgical manipulation of the nasal septum that would lead to a septal perforation. *Turbinate reduction surgery* - **Turbinate reduction** procedures target the inferior turbinates to improve nasal airflow by reducing their size. - These procedures do not involve the nasal septum itself, so a septal perforation would not be a direct or common complication. [Practice more ENT PYQs on OnCourse]

Q: A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?

CECT (Contrast-Enhanced CT). ***CECT (Contrast-Enhanced CT)*** - Given the history of recurrent nasal bleeding in an adolescent male suggestive of a **juvenile nasopharyngeal angiofibroma (JNA)**, CECT is the investigation of choice to delineate the tumor's extent, vascularity, and involvement of surrounding structures. - CECT provides crucial information for surgical planning and assessing intracranial extension due to the highly vascular nature of JNAs. *Biopsy* - Biopsy of a suspected angiofibroma is generally **contraindicated** due to the high risk of severe and uncontrolled hemorrhage because the tumor is highly vascular and lacks a true capsule. - The diagnosis of JNA is usually made based on clinical presentation and imaging findings. *X-ray* - **X-rays** (like plain radiographs of the sinuses) offer limited soft tissue detail and are **insufficient** to accurately visualize the extent or vascularity of a nasopharyngeal mass. - They may show some bony erosion but cannot provide the detailed information needed for diagnosis or surgical planning of a JNA. *FESS (Functional Endoscopic Sinus Surgery)* - **FESS** is a **surgical procedure** used for treating chronic sinusitis and other sinonasal conditions, not primarily an investigative tool for a suspected tumor like JNA. - While endoscopy is used for initial visualization, **surgery** is a treatment, and detailed imaging must precede it to understand tumor boundaries. [Practice more ENT PYQs on OnCourse]

Question 1

A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?

Accepted Answer

Cricothyroid

Answer

Posterior cricoarytenoid

Answer

Lateral cricoarytenoid

Answer

Thyroarytenoid

Question 2

In a patient with right vestibular neuronitis, what will be the finding on the head impulse test?

Accepted Answer

Head turned to right, corrective saccade to the left

Answer

Head turned to left, corrective saccade to the right

Answer

Head turned to right, no corrective saccade

Answer

Head turned to left, no corrective saccade

Question 3

A patient presents with conductive hearing loss, pulsatile tinnitus, and a positive Phelps sign. Based on the CT scan image provided, what is the most likely diagnosis?

Accepted Answer

Glomus Jugulare

Answer

Glomus Tympanicum

Answer

Acoustic Neuroma

Answer

Cholesteatoma

Question 4

A patient with chronic nasal obstruction underwent a procedure 3 months ago and now presents with recurrent epistaxis, crusting, and the clinical image showing a septal perforation. What procedure was most likely carried out?

Accepted Answer

Submucosal resection (SMR)

Answer

FESS (Functional Endoscopic Sinus Surgery)

Answer

Caldwell-Luc's procedure

Answer

Turbinate reduction surgery

Question 5

A 14-year-old child with a history of recurrent nasal bleeding has the endoscopic view provided. What is the investigation of choice?

Accepted Answer

CECT (Contrast-Enhanced CT)

Answer

Biopsy

Answer

X-ray

Answer

FESS (Functional Endoscopic Sinus Surgery)

Question 6

Which sinus drainage is impaired in the following image?

Accepted Answer

Maxillary

Answer

Ethmoid

Answer

Sphenoid

Answer

Frontal

Question 7

A female patient's pure tone audiometry (PTA) findings show the presence of a Carhart's notch. Which of the following specific clinical signs can be seen in this patient?

Accepted Answer

Schwartz sign

Answer

Hitselberger sign

Answer

Hennebert sign

Answer

Rinne test negative (conductive hearing loss)

Question 8

A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?

Accepted Answer

Otosclerosis

Answer

Ménière's disease

Answer

Ototoxicity

Answer

Noise-Induced Hearing Loss (NIHL)

NEET-PG 2024 — ENT